Basic Information
| Provider Information | |||||||||
| NPI: | 1073678793 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL HEALTH ASSOCIATION OF SAN MATEO COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2686 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940633522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503683345 | ||||||||
| FaxNumber: | 6503689017 | ||||||||
| Practice Location | |||||||||
| Address1: | 2686 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503683345 | ||||||||
| FaxNumber: | 6503689017 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | PLATTE | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6503683345 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 000004177 | 01 | CA | MEDICAL | OTHER |