MEDICARE: ALLIANCE MENTAL HEALTH

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	2084P0800X	Psychiatry Physician	A88489	CA

General Provider Information

NPI Number	:	1235368234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE MENTAL HEALTH

Provider Business Mailing Address
First Line	:	2019 WEBSTER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2329
Country	:	US
Telephone Number	:	415-572-2110
Fax Number	:	415-447-8665

Provider Business Practice Location Address
First Line	:	2019 WEBSTER ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2329
Country	:	US
Telephone Number	:	415-572-2110
Fax Number	:	415-447-8665

Authorized Official
Title or Position	:	CEO
Name	:	DR. SHAWN HERSEVOORT
Credential	:	M.D., M.P.H.
Telephone Number	:	415-572-2110

Provider Enumeration Date	:	07/10/2009
Last Update Date	:	07/10/2009

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Directions to “ALLIANCE MENTAL HEALTH ” Practice Location

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