Provider Demographics
NPI:1710397369
Name:BAY AREA CHILDREN'S ASSOCIATION OAKLAND
Entity Type:Organization
Organization Name:BAY AREA CHILDREN'S ASSOCIATION OAKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-996-7950
Mailing Address - Street 1:1175 SARATOGA AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3440
Mailing Address - Country:US
Mailing Address - Phone:408-996-7950
Mailing Address - Fax:408-996-7997
Practice Address - Street 1:111 MYRTLE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2525
Practice Address - Country:US
Practice Address - Phone:510-922-9757
Practice Address - Fax:510-922-9514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAY AREA CHILDREN'S ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty