Healthcare Provider Details

I. General information

NPI: 1649755547
Provider Name (Legal Business Name): MISS ALISA JANE WOLF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 QUINTARA ST
SAN FRANCISCO CA
94116-1273
US

IV. Provider business mailing address

3125 CESAR CHAVEZ
SAN FRANCISCO CA
94110-4722
US

V. Phone/Fax

Practice location:
  • Phone: 760-207-2452
  • Fax:
Mailing address:
  • Phone: 760-207-2452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number117718
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: