Provider Demographics
NPI:1043371321
Name:LIM, MICHAEL DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:LIM
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 1:3818 WHITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602
Mailing Address - Country:US
Mailing Address - Phone:510-307-1650
Mailing Address - Fax:510-307-1615
Practice Address - Street 1:901 NEVIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801
Practice Address - Country:US
Practice Address - Phone:510-307-1650
Practice Address - Fax:510-307-1615
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical