Provider Demographics
NPI:1043370760
Name:LUSTBADER, ALISON JOY (LCSW)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:JOY
Last Name:LUSTBADER
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 1:461 2ND ST # 451
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1498
Mailing Address - Country:US
Mailing Address - Phone:415-970-3800
Mailing Address - Fax:415-970-3855
Practice Address - Street 1:3801 3RD ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1409
Practice Address - Country:US
Practice Address - Phone:415-970-3849
Practice Address - Fax:415-970-3855
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS148561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical