MEDICARE: MARIYA MYKHAYLOVA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	87694	CA

General Provider Information

NPI Number	:	1023485018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIYA MYKHAYLOVA LCSW

Provider Business Mailing Address
First Line	:	2517 MISSION ST STE 4
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-7506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2517 MISSION ST STE 4
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-7506
Country	:	US
Telephone Number	:	628-400-6651
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2015
Last Update Date	:	02/12/2025

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