Provider Demographics
NPI:1487070074
Name:VASSILIADES, GEORGE (MFT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:VASSILIADES
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 55TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2632
Mailing Address - Country:US
Mailing Address - Phone:510-710-6826
Mailing Address - Fax:
Practice Address - Street 1:420 3RD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3809
Practice Address - Country:US
Practice Address - Phone:510-710-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT42141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist