Basic Information
| Provider Information | |||||||||
| NPI: | 1386003994 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIDOW | ||||||||
| FirstName: | TALIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2344 6TH ST | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947102412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5109814100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3214 CALIFORNIA ST UPPR | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947032614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6502692285 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2016 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 63350 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 63350 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.