Provider Demographics
NPI:1053367854
Name:SAN MATEO COUNTY
Entity type:Organization
Organization Name:SAN MATEO COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEI
Authorized Official - Middle Name:
Authorized Official - Last Name:AFRICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-613-2155
Mailing Address - Street 1:375 89TH ST
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-1802
Mailing Address - Country:US
Mailing Address - Phone:650-301-8650
Mailing Address - Fax:
Practice Address - Street 1:375 89TH ST
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1802
Practice Address - Country:US
Practice Address - Phone:650-301-8650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN MATEO COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-25
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80499ZMedicare PIN