Provider Demographics
NPI:1124229224
Name:ANN MARTIN CENTER
Entity Type:Organization
Organization Name:ANN MARTIN CENTER
Other - Org Name:PIEDMONT AVENUE ELEMENTARY SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLINICAL PROGRAMS
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD-PAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-655-7880
Mailing Address - Street 1:1375 55TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2609
Mailing Address - Country:US
Mailing Address - Phone:510-655-7880
Mailing Address - Fax:510-655-3379
Practice Address - Street 1:4314 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611
Practice Address - Country:US
Practice Address - Phone:510-654-7377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty