Provider Demographics
NPI:1942627278
Name:TRAYNOR, THERESA
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:TRAYNOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BROADWAY STE 102
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4099
Mailing Address - Country:US
Mailing Address - Phone:510-208-5936
Mailing Address - Fax:510-273-3808
Practice Address - Street 1:1000 BROADWAY STE 102
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4099
Practice Address - Country:US
Practice Address - Phone:510-208-5936
Practice Address - Fax:510-273-3808
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker