Provider Demographics
NPI:1851405377
Name:PEMBERTON, ADRIANN DIMITRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANN
Middle Name:DIMITRA
Last Name:PEMBERTON
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 1:1640 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1009
Mailing Address - Country:US
Mailing Address - Phone:404-403-1349
Mailing Address - Fax:
Practice Address - Street 1:4951 ARROYO RD
Practice Address - Street 2:BUILDING 62, ROOM 505
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9650
Practice Address - Country:US
Practice Address - Phone:925-373-4700
Practice Address - Fax:925-449-6541
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0040601041C0700X
GACSW0042121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical