Provider Demographics
NPI:1457754962
Name:PALO ALTO THERAPY A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type:Organization
Organization Name:PALO ALTO THERAPY A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:PALO ALTO THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:650-384-0342
Mailing Address - Street 1:407 SHERMAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1873
Mailing Address - Country:US
Mailing Address - Phone:650-384-0342
Mailing Address - Fax:650-327-9151
Practice Address - Street 1:407 SHERMAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1873
Practice Address - Country:US
Practice Address - Phone:650-384-0342
Practice Address - Fax:650-327-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA214701041C0700X
CA50104106H00000X
CA47815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty