Healthcare Provider Details

I. General information

NPI: 1649347287
Provider Name (Legal Business Name): WILLIAM SCOTT PLYMALE LCSW, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ETHEL AVE
MILL VALLEY CA
94941-2787
US

IV. Provider business mailing address

17 ETHEL AVE
MILL VALLEY CA
94941-2787
US

V. Phone/Fax

Practice location:
  • Phone: 415-310-4866
  • Fax:
Mailing address:
  • Phone: 415-310-4866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: