Healthcare Provider Details

I. General information

NPI: 1740464353
Provider Name (Legal Business Name): LILY WOLFF L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 SACRAMENTO ST
BERKELEY CA
94702-2739
US

IV. Provider business mailing address

3260 SACRAMENTO ST
BERKELEY CA
94702-2739
US

V. Phone/Fax

Practice location:
  • Phone: 510-601-6060
  • Fax:
Mailing address:
  • Phone: 510-601-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS24229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: