Provider Demographics
NPI:1497073977
Name:EDGEWOOD CHILDRENS AND FAMILY CENTER
Entity Type:Organization
Organization Name:EDGEWOOD CHILDRENS AND FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-682-3229
Mailing Address - Street 1:1801 VICENTE STREET EDGEWOOD CHILDREN AND FAMILY CENTER
Mailing Address - Street 2:
Mailing Address - City:SANFRANSICO
Mailing Address - State:CA
Mailing Address - Zip Code:94116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 VICENTE STREET EDGEWOOD CHILDREN AND FAMILY CENTER
Practice Address - Street 2:
Practice Address - City:SANFRANSICO
Practice Address - State:CA
Practice Address - Zip Code:94116
Practice Address - Country:US
Practice Address - Phone:415-682-3229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty