MEDICARE: KRYSTAL BATES LCSW

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	SW15237	FL
2	1041C0700X	Clinical Social Worker	LCSW110501	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720584808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTAL BATES LCSW

Provider Business Mailing Address
First Line	:	PO BOX 24101
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94623-1101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 PRESCOTT ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94607-1583
Country	:	US
Telephone Number	:	510-859-8581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	12/12/2022

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