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General NPI Number Information
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NPI Number | 1144643412
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Entity Type | Organization
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Legal Business Name | ENGAGING THE MOMENT, LLC
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 329 14TH ST # A
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City | OAKLAND
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State | CA
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Zip | 94612-3906
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Country | US
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Telephone | 510-295-8977
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Fax |
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Provider Business Mailing Address
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Address Line | 7917 WINTHROPE ST
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City | OAKLAND
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State | CA
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Zip | 94605-3654
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Country | US
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Telephone | 510-295-8977
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SAM HIMELSTEIN
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Credential | PHD
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Telephone | 510-295-8977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PSY25229
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License Number State | CA
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