Basic Information
Provider Information
NPI: 1003015835
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: THOMAS
FirstName: KAREN
MiddleName: LISA
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5275 CLAREMONT AVE
Address2:  
City: OAKLAND
State: CA
PostalCode: 946181032
CountryCode: US
TelephoneNumber: 5107018751
FaxNumber: 5106013913
Practice Location
Address1: 5275 CLAREMONT AVE.
Address2:  
City: OAKLAND
State: CA
PostalCode: 946181032
CountryCode: US
TelephoneNumber: 5107018751
FaxNumber: 5106013913
Other Information
ProviderEnumerationDate: 07/12/2007
LastUpdateDate: 04/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XLCS 23037CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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