Healthcare Provider Details

I. General information

NPI: 1437357548
Provider Name (Legal Business Name): SORELIZ ASCANIO L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 06/10/2020
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 30TH ST STE 2
OAKLAND CA
94609-3308
US

IV. Provider business mailing address

431 30TH ST STE 2
OAKLAND CA
94609-3308
US

V. Phone/Fax

Practice location:
  • Phone: 510-349-2948
  • Fax: 844-318-7054
Mailing address:
  • Phone: 510-394-2948
  • Fax: 844-318-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 25807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: