Provider Demographics
NPI:1942492913
Name:TUNG, LI TAK AGNES (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LI TAK
Middle Name:AGNES
Last Name:TUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LI TAL
Other - Middle Name:AGNES
Other - Last Name:LOUIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4527 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-2603
Mailing Address - Country:US
Mailing Address - Phone:415-337-4774
Mailing Address - Fax:415-333-2058
Practice Address - Street 1:4527 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2603
Practice Address - Country:US
Practice Address - Phone:415-337-4774
Practice Address - Fax:415-333-2058
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS161421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical