Healthcare Provider Details

I. General information

NPI: 1295887305
Provider Name (Legal Business Name): DEANNA KENDRA KOLDA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S EL CAMINO REAL
SAN MATEO CA
94403-2380
US

IV. Provider business mailing address

2600 S EL CAMINO REAL
SAN MATEO CA
94403-2380
US

V. Phone/Fax

Practice location:
  • Phone: 650-578-8691
  • Fax: 650-578-8697
Mailing address:
  • Phone: 650-578-8691
  • Fax: 650-578-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: