Provider Demographics
NPI:1629301445
Name:CHILDREN'S HOSPITAL & RESEARCH CENTER OAKLAND
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL & RESEARCH CENTER OAKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH SERICES
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-428-3885
Mailing Address - Street 1:2285 BAY ST APT 10
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1823
Mailing Address - Country:US
Mailing Address - Phone:661-313-5805
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health