Provider Demographics
NPI:1063748291
Name:GARFINKLE, FRAYDA
Entity type:Individual
Prefix:
First Name:FRAYDA
Middle Name:
Last Name:GARFINKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 BELLEVUE AVE
Mailing Address - Street 2:206
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3462
Mailing Address - Country:US
Mailing Address - Phone:510-530-1965
Mailing Address - Fax:
Practice Address - Street 1:2150 APPIAN WAY
Practice Address - Street 2:204
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2583
Practice Address - Country:US
Practice Address - Phone:510-530-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28422106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist