Provider Demographics
NPI:1710107784
Name:CITY AND COUNTY OF SAN FRANCISCO
Entity Type:Organization
Organization Name:CITY AND COUNTY OF SAN FRANCISCO
Other - Org Name:SOUTHEAST CHILD/FAMILY THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHONA
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAUTISTA-PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:415-255-3706
Mailing Address - Street 1:1525 SILVER AVENUE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134
Mailing Address - Country:US
Mailing Address - Phone:415-337-4800
Mailing Address - Fax:
Practice Address - Street 1:1525 SILVER AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134
Practice Address - Country:US
Practice Address - Phone:415-337-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY AND COUNTY OF SAN FRANCISCO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-01
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)