Provider Demographics
NPI:1518251610
Name:SUPPORTING SOCIAL SUCCESS, INC.
Entity Type:Organization
Organization Name:SUPPORTING SOCIAL SUCCESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:510-493-0855
Mailing Address - Street 1:6116 CHELTON DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2429
Mailing Address - Country:US
Mailing Address - Phone:510-493-0855
Mailing Address - Fax:
Practice Address - Street 1:6116 CHELTON DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2429
Practice Address - Country:US
Practice Address - Phone:510-493-0855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty