Basic Information
| Provider Information | |||||||||
| NPI: | 1033622881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SRIVASTAVA | ||||||||
| FirstName: | NEHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2579 SAN PABLO AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946121159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104467100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2579 SAN PABLO AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946121159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104467100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2017 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 7879 | CA | N | Behavioral Health & Social Service Providers | Counselor | Professional | 390200000X | 7879 | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.