Provider Demographics
NPI:1770853491
Name:MEDRANO, REBECCA GABRIELLA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:GABRIELLA
Last Name:MEDRANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LAKESHORE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1188
Mailing Address - Country:US
Mailing Address - Phone:510-473-6177
Mailing Address - Fax:
Practice Address - Street 1:2100 LAKESHORE AVE STE C
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1188
Practice Address - Country:US
Practice Address - Phone:510-473-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA852111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health