=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891856175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENNA KAUFMAN ULVANG LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2354 POST ST
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94115-3424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-567-8767
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6302 SHELTER CREEK LN
-----------------------------------------------------
City | SAN BRUNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94066-3872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-871-5474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS12706
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------