Healthcare Provider Details

I. General information

NPI: 1285201707
Provider Name (Legal Business Name): TIFFANI SIMONE CALCOTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 05/21/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MARKET ST FL 15
SAN FRANCISCO CA
94105-3316
US

IV. Provider business mailing address

PO BOX 451403
LOS ANGELES CA
90045-8515
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-3833
  • Fax:
Mailing address:
  • Phone: 213-464-4377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW99656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: