MEDICARE: DR. ROCHELLE WALD LCSW, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS13786	CA

General Provider Information

NPI Number	:	1689756728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROCHELLE WALD LCSW, PHD

Provider Business Mailing Address
First Line	:	4356 STEELE ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94619-2747
Country	:	US
Telephone Number	:	415-826-8215
Fax Number	:	510-531-9128

Provider Business Practice Location Address
First Line	:	1195 VALENCIA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3026
Country	:	US
Telephone Number	:	415-826-8215
Fax Number	:	510-531-9128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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