Provider Demographics
NPI:1497016588
Name:CITY OF BERKELEY
Entity Type:Organization
Organization Name:CITY OF BERKELEY
Other - Org Name:NORTH BERKELEY SENIOR CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-981-5180
Mailing Address - Street 1:1901 HEARST STREET
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709
Mailing Address - Country:US
Mailing Address - Phone:510-981-5190
Mailing Address - Fax:
Practice Address - Street 1:1901 HEARST STREET
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709
Practice Address - Country:US
Practice Address - Phone:510-981-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management