Provider Demographics
NPI:1073919254
Name:KAMIN, BRUCE D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:D
Last Name:KAMIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 SAN PABLO AVE.
Mailing Address - Street 2:#205B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612
Mailing Address - Country:US
Mailing Address - Phone:510-290-5898
Mailing Address - Fax:
Practice Address - Street 1:6355 TELEGRAPH AVE
Practice Address - Street 2:305
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1371
Practice Address - Country:US
Practice Address - Phone:510-290-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW127041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical