Provider Demographics
NPI:1710165048
Name:CENTRAL COUNTY MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:CENTRAL COUNTY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UNIT CHIEF
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:VALDES
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:650-573-2404
Mailing Address - Street 1:3080 LA SELVA ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2109
Mailing Address - Country:US
Mailing Address - Phone:650-573-2201
Mailing Address - Fax:650-572-9347
Practice Address - Street 1:3080 LA SELVA ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2109
Practice Address - Country:US
Practice Address - Phone:650-573-2201
Practice Address - Fax:650-572-9347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN MATEO COUNTY BEHAVIORAL AND RECOVERY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA696582251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care