Provider Demographics
NPI:1861811812
Name:TIMPANE, COLLEEN P (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:P
Last Name:TIMPANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BANCROFT AVE STE 125A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2457
Mailing Address - Country:US
Mailing Address - Phone:510-777-3800
Mailing Address - Fax:510-777-3806
Practice Address - Street 1:275 BRONSON WAY NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4030
Practice Address - Country:US
Practice Address - Phone:425-235-2800
Practice Address - Fax:877-516-9184
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 29453104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker