Healthcare Provider Details

I. General information

NPI: 1104261486
Provider Name (Legal Business Name): CITY OF FREMONT YOUTH AND FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 11/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 STEVENSON BLVD
FREMONT CA
94538-2336
US

IV. Provider business mailing address

39155 LIBERTY ST STE E500
FREMONT CA
94537-5006
US

V. Phone/Fax

Practice location:
  • Phone: 510-574-2114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMFC44011
License Number StateCA

VIII. Authorized Official

Name: MRS. LAURIE LINSCHEID
Title or Position: CLINICAL SUPERVISOR
Credential: MFT
Phone: 510-574-2114