Healthcare Provider Details

I. General information

NPI: 1225292287
Provider Name (Legal Business Name): MR. JEROME YALE GEFFNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W MACARTHUR BLVD MB BLDG. STE 640
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

7141 PINEHAVEN RD
OAKLAND CA
94611-1214
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1340
  • Fax:
Mailing address:
  • Phone: 510-653-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS12655
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: