Provider Demographics
NPI:1538396031
Name:YUSIM, RONALD ALLEN (LCSW)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:ALLEN
Last Name:YUSIM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 LARKSPUR PLAZA DR APT 4
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1473
Mailing Address - Country:US
Mailing Address - Phone:415-377-4371
Mailing Address - Fax:415-461-3907
Practice Address - Street 1:900 S ELISEO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2134
Practice Address - Country:US
Practice Address - Phone:415-522-3763
Practice Address - Fax:415-461-3907
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS17140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker