MEDICARE: EARLY CHILDHOOD MENTAL HEALTH PROGRAM

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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0759	OTHER	CA	MEDICAL IDENTIFIER

General Provider Information

NPI Number	:	1740332071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARLY CHILDHOOD MENTAL HEALTH PROGRAM

Provider Business Mailing Address
First Line	:	200 24TH ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1804
Country	:	US
Telephone Number	:	510-412-9200
Fax Number	:	510-412-9248

Provider Business Practice Location Address
First Line	:	200 24TH ST
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1804
Country	:	US
Telephone Number	:	510-412-9200
Fax Number	:	510-412-9248

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JEFFREY SLOAN
Credential	:	M.D., MBA
Telephone Number	:	510-412-9200

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	04/15/2024

Similar Medicare Providers

1912605601 — CLARISSA TORO
Practice Location Address:

200 24TH ST
RICHMOND, CA
94804-1804

Practice Phone: 510-412-9200
Practice Fax:

1952489270 — CONTRA COSTA COUNTY
Practice Location Address:

256 24TH ST
RICHMOND, CA
94804-1804

Practice Phone: 925-957-5429
Practice Fax:

1326113671 — DR. LISA WANG M.D.
Practice Location Address:

256 24TH ST
RICHMOND, CA
94804-1804

Practice Phone: 510-374-3420
Practice Fax:

1790845469 — MRS. GENOVEVA CALLOWAY LCSW
Practice Location Address:

256 24TH ST
RICHMOND, CA
94804-1804

Practice Phone: 510-374-3467
Practice Fax:

1245380211 — HEATHER COLEMAN PHD
Practice Location Address:

200 24TH ST
RICHMOND, CA
94804-1804

Practice Phone: 510-412-9210
Practice Fax:

1730233818 — MS. ANGELICA PRUYN LCSW 27874
Practice Location Address:

200 24TH ST
RICHMOND, CA
94804-1804

Practice Phone: 510-412-9200
Practice Fax:

Directions to “EARLY CHILDHOOD MENTAL HEALTH PROGRAM ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.