Healthcare Provider Details

I. General information

NPI: 1639664410
Provider Name (Legal Business Name): RACHEL SARAH ROSENFELD MANCUSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 WEBSTER ST
SAN FRANCISCO CA
94123-4005
US

IV. Provider business mailing address

2901 WEBSTER ST
SAN FRANCISCO CA
94123-4005
US

V. Phone/Fax

Practice location:
  • Phone: 415-687-4632
  • Fax:
Mailing address:
  • Phone: 415-687-4632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW112580
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW89723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: