Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 66543 | CA |
NPI | 1003192295 |
---|---|
Provider Name | Amy Bouvin |
First Address | San Leandro, CA 94578-1132 |
Second Address | San Francisco, CA 94109-5998 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2011 |
Last Update Date | 17/03/2018 |