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General NPI Number Information
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NPI Number | 1861353625
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Entity Type | Individual
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Provider Name | JEREMIAH WEINSTOCK HANSEN
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Gender | Male
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 11175 SAN PABLO AVE
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City | EL CERRITO
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State | CA
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Zip | 94530-2157
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Country | US
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Telephone | 510-334-4451
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Fax |
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Provider Business Mailing Address
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Address Line | 51 8TH ST APT C
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City | OAKLAND
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State | CA
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Zip | 94607-4786
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Country | US
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Telephone | 510-334-4451
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW126422
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License Number State | CA
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