Provider Demographics
NPI:1588536221
Name:SHIPNUCK, JULIAN ANDREW (ASW)
Entity type:Individual
Prefix:
First Name:JULIAN
Middle Name:ANDREW
Last Name:SHIPNUCK
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 42ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3621
Mailing Address - Country:US
Mailing Address - Phone:510-452-2063
Mailing Address - Fax:
Practice Address - Street 1:2501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2477
Practice Address - Country:US
Practice Address - Phone:510-452-2063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW134007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty