Healthcare Provider Details

I. General information

NPI: 1689269631
Provider Name (Legal Business Name): ROBERT MOSES SIMMONS IV LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 10/23/2026
Certification Date: 10/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 MISSION ST
SAN FRANCISCO CA
94103-1519
US

IV. Provider business mailing address

1171 MISSION ST
SAN FRANCISCO CA
94103-1519
US

V. Phone/Fax

Practice location:
  • Phone: 415-223-1416
  • Fax:
Mailing address:
  • Phone: 415-223-1416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number117787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: