Provider Demographics
NPI:1205966769
Name:GEBAUER, KAIRN MARY (MSW)
Entity type:Individual
Prefix:
First Name:KAIRN
Middle Name:MARY
Last Name:GEBAUER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 E 12TH ST
Mailing Address - Street 2:SUITE 259
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-3424
Mailing Address - Country:US
Mailing Address - Phone:510-269-9030
Mailing Address - Fax:510-265-8212
Practice Address - Street 1:3301 E 12TH ST
Practice Address - Street 2:SUITE 259
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3424
Practice Address - Country:US
Practice Address - Phone:510-269-9030
Practice Address - Fax:510-265-8212
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS24341104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker