Healthcare Provider Details

I. General information

NPI: 1740651447
Provider Name (Legal Business Name): EMBRACING AUTISM COLLABORATIVE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2015
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1944 MOUNTAIN BLVD
OAKLAND CA
94611-2813
US

IV. Provider business mailing address

1944 MOUNTAIN BLVD
OAKLAND CA
94611-2813
US

V. Phone/Fax

Practice location:
  • Phone: 510-692-8640
  • Fax:
Mailing address:
  • Phone: 510-692-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICOLE MARTIN
Title or Position: CO-FOUNDER
Credential:
Phone: 510-692-8640