Provider Demographics
NPI:1760524383
Name:RECHTSHAFFER, IRA (LCSW)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:
Last Name:RECHTSHAFFER
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 1:820 LAS GALLINAS AVE
Mailing Address - Street 2:KAISER PERMANENTE
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3410
Mailing Address - Country:US
Mailing Address - Phone:415-444-3522
Mailing Address - Fax:
Practice Address - Street 1:2 KEEL CT
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2250
Practice Address - Country:US
Practice Address - Phone:415-472-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS178281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical