Provider Demographics
NPI:1568514859
Name:WELLS, LLOYD EDWARD JR (LCSW)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:EDWARD
Last Name:WELLS
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GRAND AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5357
Mailing Address - Country:US
Mailing Address - Phone:415-793-4130
Mailing Address - Fax:
Practice Address - Street 1:55 SANTA CLARA AVE STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-1319
Practice Address - Country:US
Practice Address - Phone:888-588-8995
Practice Address - Fax:510-756-0812
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAASW651091041C0700X
CA915801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801983960OtherICM