Provider Demographics
NPI:1841562055
Name:BLACKMAN, ALISSA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ALISSA
Middle Name:
Last Name:BLACKMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6536 TELEGRAPH AVE
Mailing Address - Street 2:SUITE C 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1192
Mailing Address - Country:US
Mailing Address - Phone:510-496-6030
Mailing Address - Fax:
Practice Address - Street 1:6536 TELEGRAPH AVE
Practice Address - Street 2:SUITE C 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1192
Practice Address - Country:US
Practice Address - Phone:510-496-6030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#MFC48159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist