Provider Demographics
NPI:1437357548
Name:ASCANIO, SORELIZ (LCSW)
Entity Type:Individual
Prefix:
First Name:SORELIZ
Middle Name:
Last Name:ASCANIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 30TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3308
Mailing Address - Country:US
Mailing Address - Phone:510-394-2948
Mailing Address - Fax:844-318-7054
Practice Address - Street 1:431 30TH ST STE 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3308
Practice Address - Country:US
Practice Address - Phone:510-349-2948
Practice Address - Fax:844-318-7054
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 258071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical