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NPI Code Detail

MEDICARE: MS. TALA LUTUF GHANTOUS LCSW

MEDICARE: MS. TALA LUTUF GHANTOUS 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
11041C0700XClinical Social Worker25100CA

General Provider Information

NPI Number : 1801007497
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TALA LUTUF GHANTOUS LCSW
Provider Business Mailing Address
First Line : 747 52ND ST
Second Line :
City : OAKLAND
State : CA
Zip : 94609-1809
Country : US
Telephone Number : 510-428-8413
Fax Number :
Provider Business Practice Location Address
First Line : 770 53RD ST
Second Line :
City : OAKLAND
State : CA
Zip : 94609-1814
Country : US
Telephone Number : 510-428-3441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 03/10/2026

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