=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699832790
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN E PERNET MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2007
-----------------------------------------------------
Last Update Date | 12/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3725 COOLIDGE AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94602-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-923-0520
-----------------------------------------------------
Fax | 510-653-0433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3725 COOLIDGE AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94602-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-923-0520
-----------------------------------------------------
Fax | 510-653-0433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CW012918
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 23635
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------