Healthcare Provider Details

I. General information

NPI: 1386964633
Provider Name (Legal Business Name): STEFAN THOMAS CWIK B.MUS.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 POTRERO AVE L-UNIT
SAN FRANCISCO CA
94110-2869
US

IV. Provider business mailing address

887 POTRERO AVE L-UNIT
SAN FRANCISCO CA
94110-2869
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-6346
  • Fax:
Mailing address:
  • Phone: 415-206-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: