Provider Demographics
NPI:1376636118
Name:FAMILIY SERVICE OF SAN LEANDRO
Entity Type:Organization
Organization Name:FAMILIY SERVICE OF SAN LEANDRO
Other - Org Name:FAMILY SERVICE OF SAN LEANDRO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-483-6715
Mailing Address - Street 1:2208 SAN LEANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-5957
Mailing Address - Country:US
Mailing Address - Phone:510-483-6715
Mailing Address - Fax:510-483-6719
Practice Address - Street 1:2208 SAN LEANDRO BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5957
Practice Address - Country:US
Practice Address - Phone:510-483-6715
Practice Address - Fax:510-483-6719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty