=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558000653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANNAH V. STUTZ, LICENSED CLINICAL SOCIAL WORKER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2022
-----------------------------------------------------
Last Update Date | 05/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 974 RALSTON AVE STE 10
-----------------------------------------------------
City | BELMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94002-2249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-237-3421
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 584 CASTRO ST # 419
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94114-2512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PRESIDENT
-----------------------------------------------------
Name | HANNAH VILLALOBOS STUTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-237-3421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------