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General NPI Number Information
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NPI Number | 1063237774
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Entity Type | Individual
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Provider Name | LENA RAE THALER MSW
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 3301 E 12TH ST
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City | OAKLAND
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State | CA
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Zip | 94601-3424
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Country | US
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Telephone | 510-269-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 2456 HILGARD AVE APT 604
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City | BERKELEY
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State | CA
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Zip | 94709-1243
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Country | US
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Telephone | 831-713-8502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 124621
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 124621
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License Number State | CA
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