Provider Demographics
NPI:1528240868
Name:HURTADO, JOSE GUADAUPE (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:GUADAUPE
Last Name:HURTADO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 SAN LEANDRO BLVD APT 1319
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-5048
Mailing Address - Country:US
Mailing Address - Phone:831-600-5175
Mailing Address - Fax:510-868-1940
Practice Address - Street 1:10901 MACARTHUR BLVD STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605
Practice Address - Country:US
Practice Address - Phone:510-502-3280
Practice Address - Fax:510-868-1940
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW769191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW76919OtherBOARD OF BEHAVIO
CALCSW76919OtherBOARD OF BEHAVIORAL SCIENCES CALIFORNIA