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General NPI Number Information
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NPI Number | 1639450398
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Entity Type | Individual
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Provider Name | SCOTT MARION RALSTON
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Gender | Male
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 11/19/2024
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Provider Practice Location Address
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Address Line | 837 ADDISON ST
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City | BERKELEY
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State | CA
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Zip | 94710-2047
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Country | US
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Telephone | 510-981-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 526 S SAN PEDRO ST
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City | LOS ANGELES
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State | CA
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Zip | 90013-2102
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Country | US
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Telephone | 213-488-9559
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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 | 75965
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License Number State | CA
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