Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
Y | 225XM0800X | Mental Health |
NPI | 1245755818 |
---|---|
Provider Name | Nicole Mathews |
First Address | San Francisco, CA 94117-2242 |
Second Address | San Francisco, CA 94117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2017 |
Last Update Date | 01/10/2018 |