Healthcare Provider Details

I. General information

NPI: 1902820434
Provider Name (Legal Business Name): MARY HULME LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 GRANVILLE WAY
SAN FRANCISCO CA
94127-1133
US

IV. Provider business mailing address

191 GRANVILLE WAY
SAN FRANCISCO CA
94127-1133
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone: 415-221-4810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number22470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: