1912114737 NPI number — MS. LINDA CHRISTINE NELSON LCSW

Table of content: MS. LINDA CHRISTINE NELSON LCSW (NPI 1912114737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912114737 NPI number — MS. LINDA CHRISTINE NELSON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
LINDA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912114737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 BANCROFT AVE
Provider Second Line Business Mailing Address:
SUITE 125D
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94605-2403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-777-3881
Provider Business Mailing Address Fax Number:
510-777-3880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 BANCROFT AVE
Provider Second Line Business Practice Location Address:
SUITE 125D
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94605-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-777-3881
Provider Business Practice Location Address Fax Number:
510-777-3880
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 10216 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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