Provider Demographics
NPI:1194741363
Name:WAN, PAULINE S (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:S
Last Name:WAN
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 1:1732 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3130
Mailing Address - Country:US
Mailing Address - Phone:415-386-8383
Mailing Address - Fax:415-821-1080
Practice Address - Street 1:1732 FILLMORE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3130
Practice Address - Country:US
Practice Address - Phone:415-386-8383
Practice Address - Fax:415-821-1080
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 153261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical