Provider Demographics
NPI:1679778559
Name:LEWIS-CLARKE, BARBARA J
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:J
Last Name:LEWIS-CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2674 66TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-1921
Mailing Address - Country:US
Mailing Address - Phone:510-851-5965
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE STE 125D
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2415
Practice Address - Country:US
Practice Address - Phone:510-777-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0108Medicaid