Healthcare Provider Details

I. General information

NPI: 1659832186
Provider Name (Legal Business Name): DOUGLAS WEIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROLAND WAY
OAKLAND CA
94621-2034
US

IV. Provider business mailing address

5714 GASKILL ST
OAKLAND CA
94608-2716
US

V. Phone/Fax

Practice location:
  • Phone: 510-839-3800
  • Fax:
Mailing address:
  • Phone: 510-289-9633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: