Healthcare Provider Details

I. General information

NPI: 1366794521
Provider Name (Legal Business Name): OAKLAND UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 10/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 84TH AVENUE
OAKLAND CA
94605-3550
US

IV. Provider business mailing address

2850 WEST ST
OAKLAND CA
94608-4536
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-0131
  • Fax: 510-879-0133
Mailing address:
  • Phone: 510-874-3710
  • 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: GENEVIEVE SARAH HIGGINS REIS
Title or Position: CLINICAL SUPERVISOR
Credential: LCSW, PPSC
Phone: 510-874-3710