Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS11087 | CA |
NPI | 1003052168 |
---|---|
Provider Name | Mr. Robert Livingstone |
First Address | San Mateo, CA 94401-4052 |
Second Address | San Mateo, CA 94401-4052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2008 |
Last Update Date | 19/12/2008 |