Basic Information
| Provider Information | |||||||||
| NPI: | 1174953566 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REVIER | ||||||||
| FirstName: | CAMICE | ||||||||
| MiddleName: | JEANETTE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2579 SAN PABLO AVE | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946121159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104467100 | ||||||||
| FaxNumber: | 5104467191 | ||||||||
| Practice Location | |||||||||
| Address1: | 1814 FRANKLIN ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946123487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103186100 | ||||||||
| FaxNumber: | 5108303318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2013 | ||||||||
| LastUpdateDate: | 11/21/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.