Provider Demographics
NPI:1760634190
Name:SMITH-GRADY, TYRISHA GENEA (MSW STUDENT)
Entity Type:Individual
Prefix:MS
First Name:TYRISHA
Middle Name:GENEA
Last Name:SMITH-GRADY
Suffix:
Gender:F
Credentials:MSW STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2408
Mailing Address - Country:US
Mailing Address - Phone:510-465-1800
Mailing Address - Fax:510-465-1508
Practice Address - Street 1:2730 ADELINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2408
Practice Address - Country:US
Practice Address - Phone:510-465-1800
Practice Address - Fax:510-465-1508
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA941667294OtherWEST OAKLAND HEALTH COUNCIL