MEDICARE: BAY AREA EMDR

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1548032899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA EMDR

Provider Business Mailing Address
First Line	:	6119 OUTLOOK AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-1819
Country	:	US
Telephone Number	:	510-863-1647
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 THORNHILL DR
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-2144
Country	:	US
Telephone Number	:	510-863-1647
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAYA CHEEK
Credential	:	LCSW
Telephone Number	:	510-863-1647

Provider Enumeration Date	:	10/30/2023
Last Update Date	:	11/14/2023

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