Provider Demographics
NPI:1639210826
Name:DISCEPOLA, MICHAEL V (MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:V
Last Name:DISCEPOLA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 MARKET ST
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1600
Mailing Address - Country:US
Mailing Address - Phone:141-548-7310
Mailing Address - Fax:415-558-9657
Practice Address - Street 1:1035 MARKET ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1600
Practice Address - Country:US
Practice Address - Phone:415-487-3102
Practice Address - Fax:415-558-9657
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101Y00000X, 101YM0800X, 106H00000X
CA54716106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist