Provider Demographics
NPI:1689799520
Name:CITY OF BERKELEY
Entity Type:Organization
Organization Name:CITY OF BERKELEY
Other - Org Name:HEALTH, HOUSING & COMMUNITY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:MENTAL HEALTH ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATUALA
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:510-981-7654
Mailing Address - Street 1:3282 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2439
Mailing Address - Country:US
Mailing Address - Phone:510-981-5280
Mailing Address - Fax:510-596-9299
Practice Address - Street 1:2640 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3238
Practice Address - Country:US
Practice Address - Phone:510-981-5290
Practice Address - Fax:510-596-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80318ZMedicare ID - Type Unspecified