Provider Demographics
NPI:1891856175
Name:ULVANG, RENNA KAUFMAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RENNA
Middle Name:KAUFMAN
Last Name:ULVANG
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 1:6302 SHELTER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3872
Mailing Address - Country:US
Mailing Address - Phone:650-871-5474
Mailing Address - Fax:
Practice Address - Street 1:2354 POST ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3424
Practice Address - Country:US
Practice Address - Phone:415-567-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS127061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical