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General NPI Number Information
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NPI Number | 1184387839
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Entity Type | Organization
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Legal Business Name | LTAA LICENSED CLINICAL SOCIAL WORKER, PC
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 2339 3RD ST STE 50
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-3194
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Country | US
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Telephone | 415-521-6964
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Fax |
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Provider Business Mailing Address
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Address Line | 2339 3RD ST STE 50
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City | SAN FRANCISCO
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State | CA
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Zip | 94107-3194
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Country | US
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Telephone | 415-521-6964
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | LISA ABDILOVA ANDRESEN
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Credential | LCSW #104761
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Telephone | 415-890-3576
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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 |
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License Number State |
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