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	:	1174077838
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	:	2409 E 27TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-1303
Country	:	US
Telephone Number	:	510-535-2832
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	:	08/11/2016
Last Update Date	:	07/28/2022

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Directions to “FRED FINCH YOUTH CENTER ” Practice Location

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