Provider Demographics
NPI:1639292154
Name:NGUYEN, RYAN T (LCSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-2760
Mailing Address - Country:US
Mailing Address - Phone:415-352-2000
Mailing Address - Fax:415-355-2050
Practice Address - Street 1:729 FILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-2760
Practice Address - Country:US
Practice Address - Phone:415-352-2000
Practice Address - Fax:415-355-2050
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LCS196471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
17836OtherSFGH INTERNAL USE ONLY
17836OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
P49604Medicare UPIN