Provider Demographics
NPI:1548575095
Name:CORSTONE
Entity Type:Organization
Organization Name:CORSTONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, ACSW
Authorized Official - Phone:415-331-6161
Mailing Address - Street 1:33 BUCHANAN DR
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1650
Mailing Address - Country:US
Mailing Address - Phone:415-331-6161
Mailing Address - Fax:
Practice Address - Street 1:33 BUCHANAN DR
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1650
Practice Address - Country:US
Practice Address - Phone:415-331-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health