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NPI Code Detail

MEDICARE: FRED FINCH YOUTH CENTER

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 License Number License Number State
1101YM0800XMental Health Counselor
2104100000XSocial Worker
31041C0700XClinical Social Worker
4106H00000XMarriage & Family Therapist
5251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1154707867
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 : 1371 DETROIT AVE
Second Line :
City : CONCORD
State : CA
Zip : 94520-3521
Country : US
Telephone Number : 925-685-8760
Fax Number :
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : MR. THOMAS N. ALEXANDER
Credential : LCSW
Telephone Number : 510-482-2244
Provider Enumeration Date : 08/04/2015
Last Update Date : 08/31/2023

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