Provider Demographics
NPI:1275773004
Name:OLSON, KIMBERLY ALCALDE (MA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALCALDE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MAIN ST
Mailing Address - Street 2:SUITE 204D
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7070
Mailing Address - Country:US
Mailing Address - Phone:925-899-0928
Mailing Address - Fax:925-396-6085
Practice Address - Street 1:400 MAIN ST
Practice Address - Street 2:SUITE 204D
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7070
Practice Address - Country:US
Practice Address - Phone:925-899-0928
Practice Address - Fax:925-396-6085
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist