=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154527273
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSTITUTE OF HUMAN BEHAVIOR, RESEARCH AND EDUCATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2007
-----------------------------------------------------
Last Update Date | 11/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1910 CENTRAL AVE
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-769-7100
-----------------------------------------------------
Fax | 510-769-1824
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1910 CENTRAL AVE
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-769-7100
-----------------------------------------------------
Fax | 510-769-1824
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM EXECUTIVE/CLINICAL DIRECTOR
-----------------------------------------------------
Name | ESTHER COHEN
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 510-864-3510
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------