Provider Demographics
NPI:1578844668
Name:GEBREZGHI, MAKDA TSEHAIE (ASW)
Entity Type:Individual
Prefix:MS
First Name:MAKDA
Middle Name:TSEHAIE
Last Name:GEBREZGHI
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:MS
Other - First Name:MAKDA
Other - Middle Name:TSEHAIE
Other - Last Name:GEBREZEHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:982 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2911
Mailing Address - Country:US
Mailing Address - Phone:415-271-5124
Mailing Address - Fax:415-597-8004
Practice Address - Street 1:982 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2911
Practice Address - Country:US
Practice Address - Phone:415-271-5124
Practice Address - Fax:415-597-8004
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32377104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker