Provider Demographics
NPI:1235422189
Name:BOARD OF TRUSTEES FOR LELAND STANFORD JUNIOR UNIVERSITY
Entity Type:Organization
Organization Name:BOARD OF TRUSTEES FOR LELAND STANFORD JUNIOR UNIVERSITY
Other - Org Name:FACULTY STAFF HELP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, FACULTY STAFF HELP CENTER
Authorized Official - Prefix:
Authorized Official - First Name:ROSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMPERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:650-723-4577
Mailing Address - Street 1:585 CAPISTRANO WAY
Mailing Address - Street 2:MARIPOSA HOUSE
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-8550
Mailing Address - Country:US
Mailing Address - Phone:650-723-4577
Mailing Address - Fax:
Practice Address - Street 1:585 CAPISTRANO WAY
Practice Address - Street 2:MARIPOSA HOUSE
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-8550
Practice Address - Country:US
Practice Address - Phone:650-723-4577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOARD OF TRUSTEES FOR LELAND STANFORD JUNIOR UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty