Provider Demographics
NPI:1578742409
Name:RAESIDE, FRANCES TAYLOR SLACK (MFT)
Entity Type:Individual
Prefix:MRS
First Name:FRANCES
Middle Name:TAYLOR SLACK
Last Name:RAESIDE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 KENWYN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3737
Mailing Address - Country:US
Mailing Address - Phone:510-839-3424
Mailing Address - Fax:
Practice Address - Street 1:5263 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1032
Practice Address - Country:US
Practice Address - Phone:510-596-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35637101Y00000X, 101YP2500X, 106H00000X
MFC35637101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional