Healthcare Provider Details

I. General information

NPI: 1376232850
Provider Name (Legal Business Name): TIFFANY CHEROND NICOLE THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 JEFFERSON ST
OAKLAND CA
94612-1215
US

IV. Provider business mailing address

150 GRAND AVE STE 200
OAKLAND CA
94612-3726
US

V. Phone/Fax

Practice location:
  • Phone: 510-923-1099
  • Fax: 510-923-0894
Mailing address:
  • Phone: 510-923-1099
  • Fax: 510-923-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120293
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: