Provider Demographics
NPI:1033862156
Name:WITHIN REACH PSYCHOTHERAPY LCSW, INC
Entity Type:Organization
Organization Name:WITHIN REACH PSYCHOTHERAPY LCSW, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUKOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-833-6074
Mailing Address - Street 1:2930 DOMINGO AVE # 1181
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2454
Mailing Address - Country:US
Mailing Address - Phone:510-833-6074
Mailing Address - Fax:
Practice Address - Street 1:3321 SHELTER CREEK LN
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-6029
Practice Address - Country:US
Practice Address - Phone:510-833-6074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114334687Medicaid
CA1790284115Medicaid