Provider Demographics
NPI:1992907224
Name:DUARTE, SHEYLA MODESTA (LCSW)
Entity type:Individual
Prefix:
First Name:SHEYLA
Middle Name:MODESTA
Last Name:DUARTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHEYLA
Other - Middle Name:MODESTA
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1501 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2322
Mailing Address - Country:US
Mailing Address - Phone:510-535-6200
Mailing Address - Fax:
Practice Address - Street 1:1501 FRUITVALE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2322
Practice Address - Country:US
Practice Address - Phone:510-535-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 149381041C0700X
CALCS257581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
05-1063OtherFQHC MEDICARE PART A
ZZZ29799ZOtherFQHC MEDICARE PART B