Provider Demographics
NPI:1134208614
Name:HARRISON, ADA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ADA
Middle Name:M
Last Name:HARRISON
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 1:1041 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610
Mailing Address - Country:US
Mailing Address - Phone:510-834-4462
Mailing Address - Fax:510-834-4462
Practice Address - Street 1:445 BELLEVUE
Practice Address - Street 2:SUITE 104
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610
Practice Address - Country:US
Practice Address - Phone:510-834-4460
Practice Address - Fax:510-834-4460
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS39481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW039480Medicaid
CA7072533Medicaid
CACSW039480Medicaid
CAZZZ17841ZMedicare ID - Type Unspecified