Healthcare Provider Details

I. General information

NPI: 1376619437
Provider Name (Legal Business Name): PETER S MILEWICZ MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 415-206-6482
  • Fax: 415-206-6469
Mailing address:
  • Phone: 415-206-6482
  • Fax: 415-206-6469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 12619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: