Provider Demographics
NPI:1548305485
Name:MATHIS, NORMAN
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
Last Name:MATHIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 HAYES ST
Mailing Address - Street 2:APT. D
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2513
Mailing Address - Country:US
Mailing Address - Phone:415-921-5562
Mailing Address - Fax:
Practice Address - Street 1:1601 QUESADA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-2334
Practice Address - Country:US
Practice Address - Phone:415-822-5945
Practice Address - Fax:415-822-5943
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30454OtherINSYST STAFF ID NUMBER