Provider Demographics
NPI:1891121836
Name:AVIRETT, AMELIA GARAHAN (MSED)
Entity Type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:GARAHAN
Last Name:AVIRETT
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PPSC-S2 SCHOOL PSYCH
Mailing Address - Street 1:1918 UNIVERSITY AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3264
Mailing Address - Country:US
Mailing Address - Phone:510-841-1262
Mailing Address - Fax:
Practice Address - Street 1:2275 ARLINGTON DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1132
Practice Address - Country:US
Practice Address - Phone:510-317-1444
Practice Address - Fax:510-481-1605
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120021244103TS0200X
390200000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program