# SAN QUENTIN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710329925
- **Authorized official:** MR. CHRISTOPHER ROACH PSYCH. D (SUPERVISOR)
- **Authorized official phone:** (415) 454-1460

## Contact information

- **Practice address:** 1635 JOSEPHINE ST, BERKELEY, CA 94703-1320
- **Practice address phone:** (415) 454-1469
- **Mailing address:** 1635 JOSEPHINE ST, BERKELEY, CA 94703-1320
- **Mailing address phone:** (415) 454-1469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 07/29/2013
- **Last updated:** 07/29/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | LCS14462 | LCSW | CA |