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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
2103TC2200XClinical Child & Adolescent Psychologist
3106H00000XMarriage & Family Therapist
41041C0700XClinical Social Worker

General Provider Information

NPI Number : 1285768200
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 : 5555 ASCOT DR
Second Line :
City : OAKLAND
State : CA
Zip : 94611-3001
Country : US
Telephone Number : 510-879-2110
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 : 03/14/2007
Last Update Date : 10/05/2022

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