Healthcare Provider Details

I. General information

NPI: 1861026080
Provider Name (Legal Business Name): URBAN CATALYST PSYCHOTHERAPY, A LICENSED CLINICAL SOCIAL WORKER CORPOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 29TH ST STE 308
OAKLAND CA
94609-3548
US

IV. Provider business mailing address

1700 NORBRIDGE AVE # G
CASTRO VALLEY CA
94546-5700
US

V. Phone/Fax

Practice location:
  • Phone: 510-698-1100
  • Fax:
Mailing address:
  • Phone: 510-698-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. BRANDY GADSON
Title or Position: OWNER
Credential: LCSW
Phone: 510-909-1487