Provider Demographics
NPI:1962527937
Name:VERMILLION, CLAIRE COSTELLO (PHD, RN, CS)
Entity type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:COSTELLO
Last Name:VERMILLION
Suffix:
Gender:F
Credentials:PHD, RN, CS
Other - Prefix:DR
Other - First Name:CLAIRE
Other - Middle Name:LOUISE
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD, RN, CS
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:NICASIO
Mailing Address - State:CA
Mailing Address - Zip Code:94946-0755
Mailing Address - Country:US
Mailing Address - Phone:415-771-6171
Mailing Address - Fax:
Practice Address - Street 1:2919 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2116
Practice Address - Country:US
Practice Address - Phone:415-771-6171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL144420Medicare ID - Type Unspecified