Healthcare Provider Details

I. General information

NPI: 1316462252
Provider Name (Legal Business Name): JIEWEN HUANG LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2017
Last Update Date: 11/18/2022
Certification Date: 11/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 SUTTER ST STE 2
SAN FRANCISCO CA
94115-3120
US

IV. Provider business mailing address

1630 S. DELAWARE STREET 25358
SAN MATEO CA
94402
US

V. Phone/Fax

Practice location:
  • Phone: 415-298-0482
  • Fax:
Mailing address:
  • Phone: 415-298-0482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberASW84062
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: