Healthcare Provider Details

I. General information

NPI: 1134306343
Provider Name (Legal Business Name): NAN STARR INGALLS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

IV. Provider business mailing address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

V. Phone/Fax

Practice location:
  • Phone: 510-536-8111
  • Fax: 510-534-0253
Mailing address:
  • Phone: 510-536-8111
  • Fax: 510-534-0253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: