Provider Demographics
NPI:1861604274
Name:MORAN, JAMIE (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:
Last Name:MORAN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:EDWARD
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:425 GOUGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4415
Mailing Address - Country:US
Mailing Address - Phone:415-552-9408
Mailing Address - Fax:415-552-3019
Practice Address - Street 1:425 GOUGH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4415
Practice Address - Country:US
Practice Address - Phone:415-552-9408
Practice Address - Fax:415-552-3019
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 144471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical