Healthcare Provider Details

I. General information

NPI: 1992945133
Provider Name (Legal Business Name): REBECCA OLMSTED MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2009
Last Update Date: 03/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5845 COLLEGE AVE SUITE 2
OAKLAND CA
94618-1635
US

IV. Provider business mailing address

5845 COLLEGE AVE SUITE 2
OAKLAND CA
94618-1635
US

V. Phone/Fax

Practice location:
  • Phone: 510-863-4795
  • Fax:
Mailing address:
  • Phone: 510-863-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: