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General NPI Number Information
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NPI Number | 1598361487
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Entity Type | Organization
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Legal Business Name | NATALIYA PANCHENKO LCSW
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Dates
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Enumeration Date | 12/07/2020
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 851 CHERRY AVE STE 27406
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City | SAN BRUNO
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State | CA
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Zip | 94066-2900
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Country | US
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Telephone | 650-539-8689
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Fax | 650-636-9434
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Provider Business Mailing Address
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Address Line | 851 CHERRY AVE STE 27406
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City | SAN BRUNO
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State | CA
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Zip | 94066-2900
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Country | US
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Telephone | 650-539-8689
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Fax | 650-636-9434
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Authorized Official
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Title or Position | CEO/LCSW
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Name | NATALIYA PANCHENKO
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Credential |
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Telephone | 650-539-8689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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