Provider Demographics
NPI:1649538547
Name:SERVIN, NATHALIE (LCSW)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:SERVIN
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 1:1405 VAN NESS AVE APT 404
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4646
Mailing Address - Country:US
Mailing Address - Phone:831-334-5907
Mailing Address - Fax:
Practice Address - Street 1:1405 VAN NESS AVE APT 404
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4646
Practice Address - Country:US
Practice Address - Phone:831-334-5907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA959211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ918892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTNA#