Healthcare Provider Details

I. General information

NPI: 1215289467
Provider Name (Legal Business Name): OAKLAND UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 E 18TH ST
OAKLAND CA
94601-2457
US

IV. Provider business mailing address

915 54TH ST
OAKLAND CA
94608-3142
US

V. Phone/Fax

Practice location:
  • Phone: 510-436-3636
  • Fax:
Mailing address:
  • Phone: 415-816-1424
  • Fax: 510-874-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberLCSW 21739
License Number StateCA

VIII. Authorized Official

Name: KELLY LO
Title or Position: CLINICAL SUPERVISOR
Credential: LCSW , PPSC
Phone: 415-816-1424