Provider Demographics
NPI:1326239609
Name:Y TEAM
Entity Type:Organization
Organization Name:Y TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLOLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-262-6551
Mailing Address - Street 1:4963 STONERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-3872
Mailing Address - Country:US
Mailing Address - Phone:510-632-5361
Mailing Address - Fax:
Practice Address - Street 1:4175 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5774
Practice Address - Country:US
Practice Address - Phone:510-262-6551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health