Provider Demographics
NPI:1316372907
Name:NAKANISHI, DAVID MINORU (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MINORU
Last Name:NAKANISHI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 EDDY ST APT 204
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7847
Mailing Address - Country:US
Mailing Address - Phone:415-580-7674
Mailing Address - Fax:415-353-5653
Practice Address - Street 1:730 EDDY ST APT 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7847
Practice Address - Country:US
Practice Address - Phone:415-580-7674
Practice Address - Fax:415-353-5653
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS175711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical