Provider Demographics
NPI:1588653422
Name:SACHS, NIKKI N (MSW)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:N
Last Name:SACHS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11126
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94712-2126
Mailing Address - Country:US
Mailing Address - Phone:510-841-4928
Mailing Address - Fax:
Practice Address - Street 1:2931 SHATTUCK AVE
Practice Address - Street 2:STE 101
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1808
Practice Address - Country:US
Practice Address - Phone:510-841-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 38331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA150-625OtherMHN
CA217Medicaid
CA217Medicaid