Basic Information
Provider Information
NPI: 1124175393
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MERKER
FirstName: GISELA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: MFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3550 BOSTON AVE
Address2:  
City: OAKLAND
State: CA
PostalCode: 946022908
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 13666 E 14TH ST
Address2:  
City: SAN LEANDRO
State: CA
PostalCode: 945782538
CountryCode: US
TelephoneNumber: 5103575515
FaxNumber: 5103575112
Other Information
ProviderEnumerationDate: 01/03/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMFC30905CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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