Healthcare Provider Details

I. General information

NPI: 1992785042
Provider Name (Legal Business Name): MICHAEL SAMUEL GELBART LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 ESTUDILLO AVE SUITE#206
SAN LEANDRO CA
94577-4717
US

IV. Provider business mailing address

333 ESTUDILLO AVE SUITE#206
SAN LEANDRO CA
94577-4717
US

V. Phone/Fax

Practice location:
  • Phone: 510-287-2527
  • Fax: 510-357-2527
Mailing address:
  • Phone: 510-287-2527
  • Fax: 510-357-2527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS#13607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: