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General NPI Number Information
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NPI Number | 1982036984
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Entity Type | Individual
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Provider Name | SHINO DPHREPAULEZZ ASW
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Gender | Female
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 2545 SAN PABLO AVE
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City | OAKLAND
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State | CA
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Zip | 94612-1121
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Country | US
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Telephone | 510-446-7195
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Fax | 510-446-7188
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Provider Business Mailing Address
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Address Line | 3780 MOUNTAIN BLVD
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City | OAKLAND
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State | CA
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Zip | 94619-1629
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Country | US
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Telephone | 510-326-3446
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW126241
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | CA
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