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General NPI Number Information
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NPI Number | 1417429242
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Entity Type | Organization
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Legal Business Name | IDA VANDAEI LICENSED CLINICAL SOCIAL WORKER CORPORATION
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Dates
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Enumeration Date | 12/18/2018
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Last Update Date | 11/11/2023
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Provider Practice Location Address
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Address Line | 4 EMBARCADERO CTR STE 1400
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-4164
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Country | US
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Telephone | 818-646-6683
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Fax |
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Provider Business Mailing Address
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Address Line | 4 EMBARCADERO CTR STE 1400
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-4164
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Country | US
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Telephone | 818-646-6683
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | IDA VANDAEI
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Credential | LCSW
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Telephone | 818-646-6683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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