Healthcare Provider Details

I. General information

NPI: 1841335387
Provider Name (Legal Business Name): JUDITH ANN DOLAN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 FILLMORE STREET
SAN FRANCISCO CA
94112
US

IV. Provider business mailing address

2202 FILLMORE STREET
SAN FRANCISCO CA
94115
US

V. Phone/Fax

Practice location:
  • Phone: 415-254-4613
  • Fax:
Mailing address:
  • Phone: 415-254-4613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number227899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: