Healthcare Provider Details

I. General information

NPI: 1366592529
Provider Name (Legal Business Name): CAROLINE KIEMI OKANO M.A., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ESTUDILLO AVE STE 100
SAN LEANDRO CA
94577-4962
US

IV. Provider business mailing address

400 ESTUDILLO AVE STE 100
SAN LEANDRO CA
94577-4962
US

V. Phone/Fax

Practice location:
  • Phone: 510-924-0548
  • Fax:
Mailing address:
  • Phone: 510-924-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT81804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: