Provider Demographics
NPI:1154462273
Name:PARK, ALBERT (MSW)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:PARK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MARKET ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1600
Mailing Address - Country:US
Mailing Address - Phone:415-487-3113
Mailing Address - Fax:415-558-9657
Practice Address - Street 1:1035 MARKET ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1600
Practice Address - Country:US
Practice Address - Phone:415-487-3113
Practice Address - Fax:415-558-9657
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA25115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health