Healthcare Provider Details

I. General information

NPI: 1326527581
Provider Name (Legal Business Name): CENTER FOR ADOLESCENT STUDIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 07/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 KELLER AVE STE 200
OAKLAND CA
94605-4229
US

IV. Provider business mailing address

4400 KELLER AVE STE 200
OAKLAND CA
94605-4229
US

V. Phone/Fax

Practice location:
  • Phone: 510-295-8977
  • Fax:
Mailing address:
  • Phone: 510-470-5777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY25229
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY25229
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY25229
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY25229
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY25229
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25229
License Number StateCA

VIII. Authorized Official

Name: SAM HIMELSTEIN
Title or Position: CEO
Credential: PHD
Phone: 510-247-0577