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General NPI Number Information
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NPI Number | 1538396031
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Entity Type | Individual
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Provider Name | RONALD ALLEN YUSIM LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/11/2009
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Last Update Date | 02/14/2012
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Provider Practice Location Address
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Address Line | 900 S ELISEO DR SUITE 101
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City | GREENBRAE
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State | CA
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Zip | 94904-2134
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Country | US
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Telephone | 415-522-3763
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Fax | 415-461-3907
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Provider Business Mailing Address
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Address Line | 535 LARKSPUR PLAZA DR APT 4
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City | LARKSPUR
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State | CA
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Zip | 94939-1473
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Country | US
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Telephone | 415-377-4371
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Fax | 415-461-3907
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LCS17140
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License Number State | CA
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