MEDICARE: REACH PROJECT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	070753	CA

General Provider Information

NPI Number	:	1144583667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REACH PROJECT

Provider Business Mailing Address
First Line	:	3385 MAIN ST
Second Line	:	SUITE B
City	:	OAKLEY
State	:	CA
Zip	:	94561-6017
Country	:	US
Telephone Number	:	925-679-2504
Fax Number	:	925-754-2002

Provider Business Practice Location Address
First Line	:	3385 MAIN ST
Second Line	:	SUITE B
City	:	OAKLEY
State	:	CA
Zip	:	94561-6017
Country	:	US
Telephone Number	:	925-679-2504
Fax Number	:	925-754-2002

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICKIE ANGELO MARCHETTI
Credential	:	MA, RAS
Telephone Number	:	925-779-6908

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/29/2012

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Directions to “REACH PROJECT ” Practice Location

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