Provider Demographics
NPI:1831459783
Name:ANN MARTIN CENTER
Entity Type:Organization
Organization Name:ANN MARTIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL PROGRAMS
Authorized Official - Prefix:DR
Authorized Official - First Name:HASSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD-PAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-655-7880
Mailing Address - Street 1:1375 55TH ST
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2609
Mailing Address - Country:US
Mailing Address - Phone:510-655-7880
Mailing Address - Fax:510-655-3379
Practice Address - Street 1:8755 FONTAINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-4141
Practice Address - Country:US
Practice Address - Phone:510-639-3244
Practice Address - Fax:510-639-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000152251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health