Provider Demographics
NPI:1891989976
Name:SAN MATEO COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:SAN MATEO COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:CELMIRA
Authorized Official - Last Name:LUCANA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/ASW
Authorized Official - Phone:6650-372-8555
Mailing Address - Street 1:150 W 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1341
Mailing Address - Country:US
Mailing Address - Phone:650-372-8555
Mailing Address - Fax:650-341-7389
Practice Address - Street 1:150 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1341
Practice Address - Country:US
Practice Address - Phone:650-372-8555
Practice Address - Fax:650-341-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 15873302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization