Provider Demographics
NPI:1992945133
Name:OLMSTED, REBECCA (MA)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:OLMSTED
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 COLLEGE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1635
Mailing Address - Country:US
Mailing Address - Phone:510-863-4795
Mailing Address - Fax:
Practice Address - Street 1:5845 COLLEGE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1635
Practice Address - Country:US
Practice Address - Phone:510-863-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-28
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist