Healthcare Provider Details

I. General information

NPI: 1063776011
Provider Name (Legal Business Name): WILLIAM L MATHERLY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080
US

IV. Provider business mailing address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-2151
  • Fax:
Mailing address:
  • Phone: 650-742-2151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS28240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: