Provider Demographics
NPI:1184778276
Name:FOO, BEVERLY ARLENE (LCSW)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ARLENE
Last Name:FOO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BEVERLY
Other - Middle Name:ARLENE
Other - Last Name:FOO-COLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:801 TRAEGER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3048
Mailing Address - Country:US
Mailing Address - Phone:650-742-2130
Mailing Address - Fax:650-742-7135
Practice Address - Street 1:801 TRAEGER AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3048
Practice Address - Country:US
Practice Address - Phone:650-742-2130
Practice Address - Fax:650-742-7135
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS126441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical