Provider Demographics
NPI:1841351095
Name:STODDARD, TONYA (ASW)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:STODDARD
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GROVE ST RM 323
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4505
Mailing Address - Country:US
Mailing Address - Phone:415-674-9518
Mailing Address - Fax:415-346-0279
Practice Address - Street 1:988 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4183
Practice Address - Country:US
Practice Address - Phone:415-975-0908
Practice Address - Fax:415-975-9932
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 29752104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker