Provider Demographics
NPI:1790131548
Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Entity Type:Organization
Organization Name:EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILINGUAL FAMILY PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:BELEM
Authorized Official - Last Name:GARCIA LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:650-832-6708
Mailing Address - Street 1:1112 INGERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3514
Mailing Address - Country:US
Mailing Address - Phone:415-574-1005
Mailing Address - Fax:
Practice Address - Street 1:1112 INGERSON AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3514
Practice Address - Country:US
Practice Address - Phone:415-574-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty