Healthcare Provider Details

I. General information

NPI: 1548352305
Provider Name (Legal Business Name): COUNTY OF SAN MATEO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/12/2020
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 ALAMEDA DE LAS PULGAS
BELMONT CA
94002-3514
US

IV. Provider business mailing address

1400 ALAMEDA DE LAS PULGAS
BELMONT CA
94002-3514
US

V. Phone/Fax

Practice location:
  • Phone: 650-596-0354
  • Fax:
Mailing address:
  • Phone: 650-596-0354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SCOTT GILMAN
Title or Position: MENTAL HEALTH DIRECTOR
Credential:
Phone: 650-573-2748