Healthcare Provider Details

I. General information

NPI: 1811852957
Provider Name (Legal Business Name): ILIA MIRKIN & ELISA CHAVES LICENSED CLINICAL SOCIAL WORKER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ANZA ST APT 404
SAN FRANCISCO CA
94118-4390
US

IV. Provider business mailing address

400 ANZA ST APT 404
SAN FRANCISCO CA
94118-4390
US

V. Phone/Fax

Practice location:
  • Phone: 415-275-2496
  • Fax:
Mailing address:
  • Phone: 415-275-2496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ILIA MIRKIN
Title or Position: CEO
Credential: LCSW, LICSW
Phone: 415-275-2496