Provider Demographics
NPI:1619099983
Name:LONGERBEAM, SHEILA HOGAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:HOGAN
Last Name:LONGERBEAM
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 1:4230 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1602
Mailing Address - Country:US
Mailing Address - Phone:510-530-6203
Mailing Address - Fax:
Practice Address - Street 1:3852 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5353
Practice Address - Country:US
Practice Address - Phone:510-595-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist