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General NPI Number Information
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NPI Number | 1316346232
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Entity Type | Individual
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Provider Name | MITCHELL ECKSTEIN LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/15/2014
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 1700 S AMPHLETT BLVD STE 250I
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City | SAN MATEO
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State | CA
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Zip | 94402-2728
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Country | US
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Telephone | 650-458-7920
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Fax | 877-991-8755
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Provider Business Mailing Address
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Address Line | 1115 HAWTHORNE DR
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City | SAN MATEO
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State | CA
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Zip | 94402-1976
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Country | US
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Telephone | 650-458-7920
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Fax | 877-991-8755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS18381
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License Number State | CA
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