Healthcare Provider Details

I. General information

NPI: 1184798332
Provider Name (Legal Business Name): MIRA THERESE ANNA FEESS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 QUINTARA ST
SAN FRANCISCO CA
94116-1273
US

IV. Provider business mailing address

1515 QUINTARA ST
SAN FRANCISCO CA
94116-1273
US

V. Phone/Fax

Practice location:
  • Phone: 415-242-2615
  • Fax:
Mailing address:
  • Phone: 415-242-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number74703
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: