Provider Demographics
NPI:1184823809
Name:NOLAN, MARY DE CRUS (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY DE CRUS
Middle Name:
Last Name:NOLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 BROCKHURST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4222
Mailing Address - Country:US
Mailing Address - Phone:510-923-9600
Mailing Address - Fax:510-923-9606
Practice Address - Street 1:925 BROCKHURST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4222
Practice Address - Country:US
Practice Address - Phone:510-923-9600
Practice Address - Fax:510-923-9606
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS173221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical