Healthcare Provider Details

I. General information

NPI: 1982113841
Provider Name (Legal Business Name): SHENELLE MICOLE FOSTER LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 43RD ST # 1020
OAKLAND CA
94609-2138
US

IV. Provider business mailing address

490 43RD ST # 1020
OAKLAND CA
94609-2138
US

V. Phone/Fax

Practice location:
  • Phone: 510-682-2116
  • Fax:
Mailing address:
  • Phone: 510-682-2116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4715
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW132947
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC200003346
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: