Provider Demographics
NPI:1194904276
Name:ASIAN COMMUNITY MENTAL HEALTH BOARD
Entity type:Organization
Organization Name:ASIAN COMMUNITY MENTAL HEALTH BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-869-6087
Mailing Address - Street 1:310 8TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6527
Mailing Address - Country:US
Mailing Address - Phone:510-869-6000
Mailing Address - Fax:510-839-4723
Practice Address - Street 1:12240 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2453
Practice Address - Country:US
Practice Address - Phone:510-869-6000
Practice Address - Fax:510-839-4723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AIAN COMMUNITY MENTAL HEALTH BORAD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2014-09-30
Deactivation Date:2014-04-02
Deactivation Code:
Reactivation Date:2014-09-24
Provider Licenses
StateLicense IDTaxonomies
CA079200069251C00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24335ZMedicare UPIN
ZZZ24335Medicare UPIN