Healthcare Provider Details

I. General information

NPI: 1861693343
Provider Name (Legal Business Name): BONNIE LOUISE HARRISON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 CORTLAND AVE
SAN FRANCISCO CA
94110-5538
US

IV. Provider business mailing address

406 CORTLAND AVE
SAN FRANCISCO CA
94110-5538
US

V. Phone/Fax

Practice location:
  • Phone: 415-963-3549
  • Fax:
Mailing address:
  • Phone: 415-963-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW20248
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS25885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: