Healthcare Provider Details

I. General information

NPI: 1104994136
Provider Name (Legal Business Name): FAMILY SERVICE AGENCY OF THE CENTRAL COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WALNUT AVE SUITE 208
SANTA CRUZ CA
95060-3900
US

IV. Provider business mailing address

104 WALNUT AVE SUITE 208
SANTA CRUZ CA
95060-3900
US

V. Phone/Fax

Practice location:
  • Phone: 831-423-9444
  • Fax: 831-423-9444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. DAVID ARTHUR BIANCHI
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S.P.H.
Phone: 831-423-9444