Healthcare Provider Details

I. General information

NPI: 1518418532
Provider Name (Legal Business Name): LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 INTERNATIONAL BLVD
OAKLAND CA
94606-2902
US

IV. Provider business mailing address

1266 14TH ST
OAKLAND CA
94607-2205
US

V. Phone/Fax

Practice location:
  • Phone: 510-670-7619
  • Fax: 510-670-3752
Mailing address:
  • Phone: 510-531-3111
  • Fax: 510-530-8083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON STAULCUP BECWAR
Title or Position: CHIEF PROGRAM OFFICER
Credential: LCSW
Phone: 510-273-4700