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General NPI Number Information
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NPI Number | 1508289778
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Entity Type | Individual
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Provider Name | SUSAN MAK LCSW #62699
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Gender | Female
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Dates
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Enumeration Date | 01/23/2014
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | 801 PORTOLA DR STE 203
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City | SAN FRANCISCO
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State | CA
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Zip | 94127-1234
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Country | US
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Telephone | 415-212-8610
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Fax |
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Provider Business Mailing Address
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Address Line | 1487 HUNTINGTON AVE
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-5933
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Country | US
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Telephone | 650-877-5677
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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 | 62699
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License Number State | CA
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