Provider Demographics
NPI:1326242207
Name:WANG, TAFU DEREK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TAFU
Middle Name:DEREK
Last Name:WANG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:DEREK
Other - Middle Name:TAFU
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3768 HARRISON ST
Mailing Address - Street 2:APT. 202
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5085
Mailing Address - Country:US
Mailing Address - Phone:510-463-4860
Mailing Address - Fax:
Practice Address - Street 1:3768 HARRISON ST
Practice Address - Street 2:APT. 202
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5085
Practice Address - Country:US
Practice Address - Phone:510-463-4860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical