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General NPI Number Information
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NPI Number | 1366073165
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Entity Type | Individual
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Provider Name | DYNA CREASE ASW
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Gender | Female
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Dates
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Enumeration Date | 01/30/2020
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 390 40TH ST
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City | OAKLAND
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State | CA
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Zip | 94609-2633
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Country | US
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Telephone | 510-613-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 8495 PARDEE DR P.O. BOX 6156
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City | OAKLAND
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State | CA
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Zip | 94621-5098
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Country | US
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Telephone | 510-241-9031
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 128341
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 128341
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 128341
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License Number State | CA
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