Healthcare Provider Details

I. General information

NPI: 1942351473
Provider Name (Legal Business Name): DIMAS MONCADA JR. LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 MISSION ST
SAN FRANCISCO CA
94110-3104
US

IV. Provider business mailing address

1380 HOWARD ST 5TH FLOOR
SAN FRANCISCO CA
94103-2638
US

V. Phone/Fax

Practice location:
  • Phone: 415-401-2700
  • Fax: 415-401-2741
Mailing address:
  • Phone: 415-255-3699
  • Fax: 415-252-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS16093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: