Basic Information
| Provider Information | |||||||||
| NPI: | 1114328770 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEO | ||||||||
| FirstName: | ZONA | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SAINT VINCENTS DR | ||||||||
| Address2: | |||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949031504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4155074203 | ||||||||
| FaxNumber: | 4154910842 | ||||||||
| Practice Location | |||||||||
| Address1: | 823 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941182510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156101649 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2014 | ||||||||
| LastUpdateDate: | 04/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | ASW63762 | CA | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.