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General NPI Number Information
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NPI Number | 1750586574
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Entity Type | Organization
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Legal Business Name | SANTA CLARA COUNTY PALS PROGRAM
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 W HEDDING ST
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City | SAN JOSE
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State | CA
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Zip | 95110-1706
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Country | US
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Telephone | 408-896-6986
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Fax |
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Provider Business Mailing Address
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Address Line | 871 ENBORG CT
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City | SAN JOSE
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State | CA
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Zip | 95128-2645
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Country | US
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Telephone | 408-896-6986
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR
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Name | MARYANN BARRY
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Credential |
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Telephone | 408-885-6708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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