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General NPI Number Information
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NPI Number | 1104900752
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Entity Type | Individual
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Provider Name | LYNN MARIE WAHL LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 250 BON AIR RD MARIN GENERAL HOSPITAL
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City | GREENBRAE
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State | CA
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Zip | 94904-1702
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Country | US
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Telephone | 415-925-7495
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Fax |
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Provider Business Mailing Address
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Address Line | 489 CORTE MADERA AVE
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City | CORTE MADERA
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State | CA
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Zip | 94925-1310
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Country | US
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Telephone | 415-924-7790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 19033
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License Number State | CA
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