| Peninsula Counseling And Consulting Inc Ryan Gardner | |
|
3099 Telegraph Ave Berkeley CA 94705-2035 | |
| (650) 644-4454 | |
| (650) 644-4456 |
| Full Name | Peninsula Counseling And Consulting Inc Ryan Gardner |
|---|---|
| Speciality | Social Worker |
| Location | 3099 Telegraph Ave, Berkeley, California |
| Authorized Official Name and Position | Ryan Gardner (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5107784494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peninsula Counseling And Consulting Inc Ryan Gardner 1259 El Camino Real # 136 Menlo Park CA 94025-4208 Ph: (650) 644-4454 | Peninsula Counseling And Consulting Inc Ryan Gardner 3099 Telegraph Ave Berkeley CA 94705-2035 Ph: (650) 644-4454 |
| NPI Number | 1265044168 |
|---|---|
| Provider Enumeration Date | 08/21/2020 |
| Last Update Date | 08/17/2021 |
| Certification Date | 08/17/2021 |
| Medicare PECOS PAC ID | 1658778907 |
|---|---|
| Medicare Enrollment ID | O20210929000914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265044168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Ryan Gardner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477796225 PECOS PAC ID: 4385999481 Enrollment ID: I20180613001641 |
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