NPIMap

Organization Active NPI

City of Berkeley

  • Adolescent and Children Mental Health Clinic/Center
  • Berkeley, CA
National Provider Identifier
1750415113
Registry record updated Oct 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
CITY OF BERKELEY
Practice address
1521 University Ave
Berkeley, CA 94703-1422
Phone
(510) 981-5280
Fax
(510) 981-5255
NPI assigned
Mar 15, 2007
Last updated
Oct 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Steve Grolnic-McClurg
Title
Manager of Mental Health
Phone
(510) 981-5280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary

Addresses

Primary practice location

1521 University Ave
Berkeley, CA 94703-1422

Mailing address

2180 Milvia St.
2ND Floor
Berkeley, CA 94704-1122
Phone (510) 981-5270

Other names 1

  • FAMILY YOUTH AND CHILDREN Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170525001891 CA Part B Supplier - Clinic/Group Practice 5294634606 Receives reassigned benefits from 32 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Berkeley, CA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1521 University Ave
Berkeley, CA 94703
Phone (510) 981-5249

2180 Milvia St
#2
Berkeley, CA 94704

2180 Milvia St
Fl 2
Berkeley, CA 94704
Phone (510) 981-5116

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633564800000",
    "number": "1750415113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2180 MILVIA ST.",
            "address_2": "2ND FLOOR",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041122",
            "telephone_number": "510-981-5270",
            "fax_number": "510-981-5235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 UNIVERSITY AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947031422",
            "telephone_number": "510-981-5280",
            "fax_number": "510-981-5255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF BERKELEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2021-10-07",
        "certification_date": "2021-10-07",
        "status": "A",
        "authorized_official_last_name": "GROLNIC-MCCLURG",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "MANAGER OF MENTAL HEALTH",
        "authorized_official_telephone_number": "510-981-5280"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY YOUTH AND CHILDREN",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "FAMILY YOUTH AND CHILDREN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.