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NPI Code Detail

MEDICARE: CONTRA COSTA COUNTY HEALTH SERVICES

MEDICARE: CONTRA COSTA COUNTY HEALTH SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist16497CA

General Provider Information

NPI Number : 1164575940
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONTRA COSTA COUNTY HEALTH SERVICES
Provider Business Mailing Address
First Line : 303 41ST ST
Second Line :
City : RICHMOND
State : CA
Zip : 94805-2221
Country : US
Telephone Number : 510-374-7159
Fax Number : 510-374-3857
Provider Business Practice Location Address
First Line : 303 41ST ST
Second Line :
City : RICHMOND
State : CA
Zip : 94805-2221
Country : US
Telephone Number : 510-374-7159
Fax Number : 510-374-3857
Authorized Official
Title or Position : PROGARM SUPERVISOR
Name : JON ERIC STENSON
Credential : PH.D.
Telephone Number : 510-374-7159
Provider Enumeration Date : 01/18/2007
Last Update Date : 08/08/2008

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Directions to “CONTRA COSTA COUNTY HEALTH SERVICES ” Practice Location

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