MEDICARE: FRED FINCH YOUTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	1041C0700X	Clinical Social Worker
4	106H00000X	Marriage & Family Therapist
5	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003596461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED FINCH YOUTH CENTER

Provider Business Mailing Address
First Line	:	3800 COOLIDGE AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-3311
Country	:	US
Telephone Number	:	510-482-2244
Fax Number	:	510-488-1960

Provider Business Practice Location Address
First Line	:	611 PACIFICA AVE
Second Line	:
City	:	BAY POINT
State	:	CA
Zip	:	94565-1359
Country	:	US
Telephone Number	:	925-458-6101
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. THOMAS N ALEXANDER
Credential	:
Telephone Number	:	510-482-2244

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	08/31/2023

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Directions to “FRED FINCH YOUTH CENTER ” Practice Location

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