Provider Demographics
NPI:1043489628
Name:SHOOSHANI, BITA RAQUELLE (MS, LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:BITA
Middle Name:RAQUELLE
Last Name:SHOOSHANI
Suffix:
Gender:F
Credentials:MS, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 MACARTHUR BLVD # 9703
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94613-1301
Mailing Address - Country:US
Mailing Address - Phone:401-500-6319
Mailing Address - Fax:
Practice Address - Street 1:3225 LAKESHORE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2719
Practice Address - Country:US
Practice Address - Phone:401-500-6319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42182106H00000X
RIMHC00619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist