Provider Demographics
NPI:1114648243
Name:FRUHINSHOLZ, MAGALIE M
Entity Type:Individual
Prefix:
First Name:MAGALIE
Middle Name:M
Last Name:FRUHINSHOLZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MAGALIE
Other - Middle Name:M
Other - Last Name:FRUHINSHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:OFFICE
Mailing Address - Street 2:390 40TH STREET
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-7124
Mailing Address - Country:US
Mailing Address - Phone:510-826-7235
Mailing Address - Fax:510-826-7235
Practice Address - Street 1:OFFICE
Practice Address - Street 2:390 40TH STREET
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-7124
Practice Address - Country:US
Practice Address - Phone:510-826-7235
Practice Address - Fax:510-826-7235
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101Y00000XMedicaid