Provider Demographics
NPI:1821022591
Name:MAH, RONALD (MA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:MAH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18937 BRICKELL WAY
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-2411
Mailing Address - Country:US
Mailing Address - Phone:510-614-5641
Mailing Address - Fax:510-889-6553
Practice Address - Street 1:433 ESTUDILLO AVE STE 305
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4915
Practice Address - Country:US
Practice Address - Phone:510-614-5641
Practice Address - Fax:510-889-6553
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8166OtherACBHCS, ALAMEDA COUNTY BE