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General NPI Number Information
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NPI Number | 1992878342
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Entity Type | Individual
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Provider Name | ELLY LIN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 110 GOUGH ST STE 203
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City | SAN FRANCISCO
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State | CA
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Zip | 94102
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Country | US
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Telephone | 415-236-3819
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Fax |
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Provider Business Mailing Address
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Address Line | 2031 17TH AVE
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City | SAN FRANCISCO
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State | CA
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Zip | 94116-1245
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Country | US
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Telephone | 415-236-3819
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 24380
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License Number State | CA
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