Provider Demographics
NPI:1013103381
Name:SAN MATEO COUNTY
Entity Type:Organization
Organization Name:SAN MATEO COUNTY
Other - Org Name:HARBOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEI
Authorized Official - Middle Name:
Authorized Official - Last Name:AFRICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-613-2155
Mailing Address - Street 1:310 HARBOR BLVD
Mailing Address - Street 2:BUILDING E
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-4018
Mailing Address - Country:US
Mailing Address - Phone:650-599-1093
Mailing Address - Fax:650-368-2702
Practice Address - Street 1:310 HARBOR BLVD
Practice Address - Street 2:BUILDING E
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-4018
Practice Address - Country:US
Practice Address - Phone:650-599-1093
Practice Address - Fax:650-368-2702
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL HEALTH AND RECOVERY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-20
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80499ZMedicare PIN