MEDICARE: MR. ALBERT PARK MSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor	25115	CA

General Provider Information

NPI Number	:	1154462273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALBERT PARK MSW

Provider Business Mailing Address
First Line	:	1035 MARKET ST
Second Line	:	SUITE 400
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1600
Country	:	US
Telephone Number	:	415-487-3113
Fax Number	:	415-558-9657

Provider Business Practice Location Address
First Line	:	1035 MARKET ST
Second Line	:	SUITE 400
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1600
Country	:	US
Telephone Number	:	415-487-3113
Fax Number	:	415-558-9657

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	02/22/2011

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Directions to “ MR. ALBERT PARK MSW” Practice Location

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