Basic Information
| Provider Information | |||||||||
| NPI: | 1861804007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLATT | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | CAADE-I 4014-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 931 | ||||||||
| Address2: | |||||||||
| City: | HALF MOON BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078130440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 826 MAHLER ROAD | ||||||||
| Address2: | |||||||||
| City: | BURLINGAME | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506895597 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2014 | ||||||||
| LastUpdateDate: | 05/22/2014 | ||||||||
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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 | 101YA0400X | 4014-R | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.