Basic Information
Provider Information
NPI: 1003016247
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HALL
FirstName: SANDRA
MiddleName: JOCELYNN
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1748 MARKET ST
Address2: SUITE 201
City: SAN FRANCISCO
State: CA
PostalCode: 941025800
CountryCode: US
TelephoneNumber: 4159017128
FaxNumber: 4152527512
Practice Location
Address1: 1748 MARKET ST
Address2: SUITE 201
City: SAN FRANCISCO
State: CA
PostalCode: 941025800
CountryCode: US
TelephoneNumber: 4159017128
FaxNumber: 4152527512
Other Information
ProviderEnumerationDate: 07/24/2007
LastUpdateDate: 09/01/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X26729CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041C0700XASW20900CAN Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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