Provider Demographics
NPI:1669598553
Name:FOLSOM, BRUCE A (LCSW)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:FOLSOM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-1014
Mailing Address - Country:US
Mailing Address - Phone:415-337-4722
Mailing Address - Fax:415-337-2415
Practice Address - Street 1:3905 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1014
Practice Address - Country:US
Practice Address - Phone:415-337-4722
Practice Address - Fax:415-337-2415
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS130371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4741OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
4741OtherSFGH INTERNAL USE ONLY