Provider Demographics
NPI:1881784858
Name:UNION STREET HEALTH ASSOC INC
Entity type:Organization
Organization Name:UNION STREET HEALTH ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:ANA
Authorized Official - Last Name:SERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-931-3819
Mailing Address - Street 1:2084 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123
Mailing Address - Country:US
Mailing Address - Phone:415-931-3819
Mailing Address - Fax:415-563-2457
Practice Address - Street 1:2084 UNION STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123
Practice Address - Country:US
Practice Address - Phone:415-931-3819
Practice Address - Fax:415-563-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11092103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty