MEDICARE: CITY & COUNTY OF SAN FRANCISCO

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1255440970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY & COUNTY OF SAN FRANCISCO

Provider Business Mailing Address
First Line	:	1380 HOWARD ST
Second Line	:	5TH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-2638
Country	:	US
Telephone Number	:	415-252-3056
Fax Number	:	415-252-3032

Provider Business Practice Location Address
First Line	:	3850 17TH ST.
Second Line	:	SUITE 204
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-2031
Country	:	US
Telephone Number	:	415-934-7700
Fax Number	:	415-558-8221

Authorized Official
Title or Position	:	MENTAL HEALTH MANAGER
Name	:	MS. LAURIE BETH LENROW
Credential	:	LCSW
Telephone Number	:	415-934-7732

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	06/13/2011

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