Provider Demographics
NPI:1225352925
Name:LINCOLN CHILD CENTER
Entity Type:Organization
Organization Name:LINCOLN CHILD CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SCHOOL-BASED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:STAULCUP
Authorized Official - Last Name:BECWAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-867-0944
Mailing Address - Street 1:4368 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-2529
Mailing Address - Country:US
Mailing Address - Phone:510-531-3111
Mailing Address - Fax:
Practice Address - Street 1:581 61ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1248
Practice Address - Country:US
Practice Address - Phone:510-531-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000054BMOtherMEDI-CAL PROVIDER NUMBER