Provider Demographics
NPI:1871726786
Name:KIRILUK, SANDE (MS, MFT)
Entity type:Individual
Prefix:
First Name:SANDE
Middle Name:
Last Name:KIRILUK
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MONTGOMERY ST
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-3402
Mailing Address - Country:US
Mailing Address - Phone:415-721-2868
Mailing Address - Fax:
Practice Address - Street 1:220 MONTGOMERY ST
Practice Address - Street 2:SUITE 1800
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3402
Practice Address - Country:US
Practice Address - Phone:415-721-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist