Provider Demographics
NPI:1790802445
Name:LOI, NGOC (LCSW)
Entity Type:Individual
Prefix:
First Name:NGOC
Middle Name:
Last Name:LOI
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 1:3270 KERNER BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4840
Mailing Address - Country:US
Mailing Address - Phone:415-473-2741
Mailing Address - Fax:415-473-3850
Practice Address - Street 1:3270 KERNER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-2741
Practice Address - Fax:415-473-3850
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101Y00000X
CALCSW635711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11262OtherSFGH INTERNAL USE ONLY
11262OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER