Provider Demographics
NPI:1316435886
Name:PARTNERSHIPS FOR TRAUMA RECOVERY
Entity type:Organization
Organization Name:PARTNERSHIPS FOR TRAUMA RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GIANINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PELLEGRINI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-730-2386
Mailing Address - Street 1:2526 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2607
Mailing Address - Country:US
Mailing Address - Phone:510-969-2581
Mailing Address - Fax:
Practice Address - Street 1:2526 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2607
Practice Address - Country:US
Practice Address - Phone:510-969-2581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134496052Medicaid