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General NPI Number Information
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NPI Number | 1922151166
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Entity Type | Individual
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Provider Name | JUDY GUSTIN LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6221 GEARY BLVD
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-1821
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Country | US
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Telephone | 415-386-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 GOUGH ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-7622
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSC 19564
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License Number State | CA
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