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General NPI Number Information
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NPI Number | 1396178968
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Entity Type | Individual
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Provider Name | ILIA MIRKIN
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Gender | Male
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Dates
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Enumeration Date | 08/18/2013
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 400 ANZA ST APT 404
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City | SAN FRANCISCO
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State | CA
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Zip | 94118-4390
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Country | US
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Telephone | 415-275-2496
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Fax |
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Provider Business Mailing Address
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Address Line | 400 ANZA ST APT 404
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City | SAN FRANCISCO
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State | CA
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Zip | 94118-4390
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Country | US
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Telephone | 415-275-2496
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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 | 04256
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW24585
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW04256
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 904018416
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 82847
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License Number State | CA
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