Healthcare Provider Details

I. General information

NPI: 1033735436
Provider Name (Legal Business Name): AMIE LOIS RUDOLPH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/22/2020
Certification Date: 06/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCSF BENIOFF CHILDREN'S HOSPITAL 1975 4TH STREET
SAN FRANCISCO CA
94930
US

IV. Provider business mailing address

UCSF BENIOFF CHILDREN'S HOSPITAL 1975 4TH STREET
SAN FRANCISCO CA
94930
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-4272
  • Fax: 415-476-5363
Mailing address:
  • Phone: 415-476-4272
  • Fax: 415-476-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW22250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: