Provider Demographics
NPI:1073650529
Name:NILSSON, STOOP (LPT)
Entity Type:Individual
Prefix:
First Name:STOOP
Middle Name:
Last Name:NILSSON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:STOOP
Other - Middle Name:
Other - Last Name:NILSSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2059 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1119
Mailing Address - Country:US
Mailing Address - Phone:415-678-8290
Mailing Address - Fax:
Practice Address - Street 1:52 DORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-3828
Practice Address - Country:US
Practice Address - Phone:415-553-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health