Healthcare Provider Details

I. General information

NPI: 1811378946
Provider Name (Legal Business Name): CHANTAL SIMONETTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 LOMA VISTA AVE
OAKLAND CA
94619-1426
US

IV. Provider business mailing address

3906 LOMA VISTA AVE
OAKLAND CA
94619-1426
US

V. Phone/Fax

Practice location:
  • Phone: 510-302-8951
  • Fax: 510-479-1180
Mailing address:
  • Phone: 510-302-8951
  • Fax: 510-479-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: