Healthcare Provider Details

I. General information

NPI: 1336207471
Provider Name (Legal Business Name): JAMES LACROCE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 18TH ST STE 301
SAN FRANCISCO CA
94110-2076
US

IV. Provider business mailing address

49 HIGH ST #2
SAN FRANCISCO CA
94114-3541
US

V. Phone/Fax

Practice location:
  • Phone: 415-794-0343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: