Healthcare Provider Details

I. General information

NPI: 1346407798
Provider Name (Legal Business Name): ALGERNOL D BOOZER MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 125A
OAKLAND CA
94605-2457
US

IV. Provider business mailing address

7200 BANCROFT AVENUE SUITE 125A
OAKLAND CA
94605
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-3820
  • Fax: 510-777-3806
Mailing address:
  • Phone: 510-777-3820
  • Fax: 510-777-3806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23253
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: