Provider Demographics
NPI:1124300090
Name:HARADA, CLAYTON I
Entity type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:I
Last Name:HARADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 BROADWAY
Mailing Address - Street 2:SUITE 700
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2041
Mailing Address - Country:US
Mailing Address - Phone:510-832-1315
Mailing Address - Fax:510-832-1743
Practice Address - Street 1:1440 BROADWAY
Practice Address - Street 2:SUITE 700
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2041
Practice Address - Country:US
Practice Address - Phone:510-832-1315
Practice Address - Fax:510-832-1743
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health