MEDICARE: THE SUPPORT PROJECT, INC

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	LCS 15838	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ33489Z	OTHER	CA	BLUE SHIELD OF CA

General Provider Information

NPI Number	:	1225060874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SUPPORT PROJECT, INC

Provider Business Mailing Address
First Line	:	3527 SACRAMENTO ST STE 102
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1884
Country	:	US
Telephone Number	:	415-563-3294
Fax Number	:	510-531-4764

Provider Business Practice Location Address
First Line	:	3527 SACRAMENTO ST STE 102
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1884
Country	:	US
Telephone Number	:	415-563-3294
Fax Number	:	510-531-4764

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT COE
Credential	:	LCSW
Telephone Number	:	415-563-3294

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/22/2020

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Directions to “THE SUPPORT PROJECT, INC ” Practice Location

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