Provider Demographics
NPI:1982994869
Name:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Entity type:Organization
Organization Name:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-428-3885
Mailing Address - Street 1:747 52ND STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-428-3840
Practice Address - Street 1:2607 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3415
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-428-3840
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-13
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000015261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health