Provider Demographics
NPI:1376045591
Name:LI, MICHAEL (ASW124746)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:ASW124746
Other - Prefix:
Other - First Name:MIKEY
Other - Middle Name:
Other - Last Name:LI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:310 8TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6527
Mailing Address - Country:US
Mailing Address - Phone:408-735-3900
Mailing Address - Fax:510-735-3941
Practice Address - Street 1:310 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6527
Practice Address - Country:US
Practice Address - Phone:510-735-3900
Practice Address - Fax:510-735-3941
Is Sole Proprietor?:No
Enumeration Date:2018-03-03
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 171M00000X
CAASW124746104100000X
CAR1347720519101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator