Healthcare Provider Details

I. General information

NPI: 1124336565
Provider Name (Legal Business Name): ERICK F REIJERSE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 POLK ST
SAN FRANCISCO CA
94102-3333
US

IV. Provider business mailing address

760 HARRISON ST
SAN FRANCISCO CA
94107-1235
US

V. Phone/Fax

Practice location:
  • Phone: 628-217-6432
  • Fax: 415-292-2030
Mailing address:
  • Phone: 415-836-1700
  • Fax: 415-836-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number81729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: