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General NPI Number Information
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NPI Number | 1912647207
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Entity Type | Organization
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Legal Business Name | EAST BAY ART THERAPY
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 55 SANTA CLARA AVE STE 220
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City | OAKLAND
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State | CA
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Zip | 94610-1375
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Country | US
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Telephone | 510-675-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 55 SANTA CLARA AVE STE 220
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City | OAKLAND
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State | CA
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Zip | 94610-1375
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Country | US
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Telephone | 510-675-7070
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. TONIA NALEEN HERRERO
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Credential | MPS, ATR-BC, LCAT
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Telephone | 510-675-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number |
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License Number State |
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