MEDICARE: HEATH ALLEN HODGE 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	80489	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093880494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATH ALLEN HODGE LCSW

Provider Business Mailing Address
First Line	:	1500 FRANKLIN ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4523
Country	:	US
Telephone Number	:	415-474-7310
Fax Number	:	415-931-3773

Provider Business Practice Location Address
First Line	:	1500 FRANKLIN ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-4523
Country	:	US
Telephone Number	:	415-474-7310
Fax Number	:	415-931-3773

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	12/05/2018

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