Provider Demographics
NPI:1386760270
Name:SAN MIGUEL, ROBAN L (LCSW)
Entity type:Individual
Prefix:
First Name:ROBAN
Middle Name:L
Last Name:SAN MIGUEL
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 1:375 WOODSIDE AVE
Mailing Address - Street 2:BLDG W-3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1221
Mailing Address - Country:US
Mailing Address - Phone:415-753-7784
Mailing Address - Fax:415-753-7759
Practice Address - Street 1:375 WOODSIDE AVE
Practice Address - Street 2:BLDG W-3
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1221
Practice Address - Country:US
Practice Address - Phone:415-753-7784
Practice Address - Fax:415-753-7759
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
CALCS128401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5732OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
5732OtherSFGH INTERNAL USE ONLY