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General NPI Number Information
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NPI Number | 1174724090
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Entity Type | Individual
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Provider Name | MISA TROTMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 01/12/2025
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Provider Practice Location Address
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Address Line | 777 DAVIS ST STE 300
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City | SAN LEANDRO
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State | CA
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Zip | 94577-6923
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Country | US
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Telephone | 510-468-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 2710 CROW CANYON RD # 1074
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City | SAN RAMON
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State | CA
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Zip | 94583-1606
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Country | US
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Telephone | 925-263-9592
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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 | LCSW 20625
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License Number State | CA
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