Provider Demographics
NPI:1942228416
Name:SOLOMON, THEODORE THOMAS (LISW)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:THOMAS
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 STEINER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3118
Mailing Address - Country:US
Mailing Address - Phone:415-238-1266
Mailing Address - Fax:
Practice Address - Street 1:1990 41ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1101
Practice Address - Country:US
Practice Address - Phone:415-753-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN3915Medicaid