Provider Demographics
NPI:1205262177
Name:CITY OF FREMONT
Entity type:Organization
Organization Name:CITY OF FREMONT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-574-2135
Mailing Address - Street 1:39155 LIBERTY ST
Mailing Address - Street 2:SUITE E 500
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1513
Mailing Address - Country:US
Mailing Address - Phone:510-574-2100
Mailing Address - Fax:510-574-2105
Practice Address - Street 1:4455 SENECA PARK AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-4028
Practice Address - Country:US
Practice Address - Phone:510-657-9155
Practice Address - Fax:510-657-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70253412200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health