Provider Demographics
NPI:1194030999
Name:COUNSELING SERVICES FOR SENIORS, A LICENSED CLINICAL SOCIAL WORKER CO
Entity Type:Organization
Organization Name:COUNSELING SERVICES FOR SENIORS, A LICENSED CLINICAL SOCIAL WORKER CO
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-332-3631
Mailing Address - Street 1:466 CRESCENT ST
Mailing Address - Street 2:#112
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2662
Mailing Address - Country:US
Mailing Address - Phone:510-332-3631
Mailing Address - Fax:866-711-3422
Practice Address - Street 1:466 CRESCENT ST
Practice Address - Street 2:#112
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2662
Practice Address - Country:US
Practice Address - Phone:510-332-3631
Practice Address - Fax:866-711-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23379103TC0700X
CA247681041C0700X
CA254781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEE495AMedicare PIN
CACA172496Medicare PIN