Healthcare Provider Details

I. General information

NPI: 1568885564
Provider Name (Legal Business Name): LUSETTE OKADA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 GATEWAY BLVD FL 4
SOUTH SAN FRANCISCO CA
94080-7401
US

IV. Provider business mailing address

801 GATEWAY BLVD FL 4
SOUTH SAN FRANCISCO CA
94080-7401
US

V. Phone/Fax

Practice location:
  • Phone: 650-713-8570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS29661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: