Provider Demographics
NPI:1598023764
Name:PAK, QUARRY (LCSW)
Entity Type:Individual
Prefix:
First Name:QUARRY
Middle Name:
Last Name:PAK
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:PO BOX 591073
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94159-1073
Mailing Address - Country:US
Mailing Address - Phone:415-236-3870
Mailing Address - Fax:
Practice Address - Street 1:1637 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1813
Practice Address - Country:US
Practice Address - Phone:415-236-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45-4614952OtherEMPLOYEE IDENTIFICATION NUMBER