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General NPI Number Information
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NPI Number | 1831323682
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Entity Type | Organization
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Legal Business Name | FAMILY CENTER FOR SEXUAL ABUSE PREVENTION AND THERAPY
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 1904 FRANKLIN ST SUITE 703
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City | OAKLAND
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State | CA
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Zip | 94612-2912
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Country | US
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Telephone | 510-832-2574
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Fax | 510-832-2562
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Provider Business Mailing Address
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Address Line | 1904 FRANKLIN ST SUITE 703
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City | OAKLAND
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State | CA
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Zip | 94612-2912
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Country | US
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Telephone | 510-832-2574
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Fax | 510-832-2562
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | CAROLINA IVETTE ROSALES-WYMAN
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Credential | LCSW
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Telephone | 510-832-2574
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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 | LCS 22815
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License Number State | CA
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