Provider Demographics
NPI:1437526209
Name:UNIHEALTH, LICENSED CLINICAL SOCIAL WORKER, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:UNIHEALTH, LICENSED CLINICAL SOCIAL WORKER, PROFESSIONAL CORPORATION
Other - Org Name:UNIHEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGOS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:415-562-4156
Mailing Address - Street 1:3150 18TH ST STE 350
Mailing Address - Street 2:MAILBOX #202
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2077
Mailing Address - Country:US
Mailing Address - Phone:415-562-4156
Mailing Address - Fax:
Practice Address - Street 1:3150 18TH ST STE 350
Practice Address - Street 2:MAILBOX #202
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2077
Practice Address - Country:US
Practice Address - Phone:415-562-4156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty