Provider Demographics
NPI:1023432770
Name:TILSON, CHARLOTTE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:
Last Name:TILSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 LAUREL ST STE 12
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1952
Mailing Address - Country:US
Mailing Address - Phone:415-335-8640
Mailing Address - Fax:
Practice Address - Street 1:399 LAUREL ST STE 12
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1952
Practice Address - Country:US
Practice Address - Phone:415-335-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25357103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist