Healthcare Provider Details

I. General information

NPI: 1225166317
Provider Name (Legal Business Name): SANTA CLARA COUNTY DADS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

976 LENZEN AVE FIRST FLOOR
SAN JOSE CA
95126-2737
US

IV. Provider business mailing address

976 LENZEN AVE FIRST FLOOR
SAN JOSE CA
95126-2737
US

V. Phone/Fax

Practice location:
  • Phone: 408-792-5247
  • Fax: 408-947-8719
Mailing address:
  • Phone: 408-792-5247
  • Fax: 408-947-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberASW 13459
License Number StateCA

VIII. Authorized Official

Name: MS. LAURIE ANN SMITH
Title or Position: PSYCHIATRIC SOCIAL WORKER 1
Credential: MSW
Phone: 408-792-5247