Provider Demographics
NPI:1306671086
Name:JEFFREY GIANELLI LICENSED CLINICAL SOCIAL WORK A PROFESSIONAL CORP
Entity type:Organization
Organization Name:JEFFREY GIANELLI LICENSED CLINICAL SOCIAL WORK A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-543-0323
Mailing Address - Street 1:4154 PIEDMONT AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5171
Mailing Address - Country:US
Mailing Address - Phone:510-543-0323
Mailing Address - Fax:
Practice Address - Street 1:445 BELLEVUE AVE STE 6A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4923
Practice Address - Country:US
Practice Address - Phone:510-543-0323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty