Provider Demographics
NPI:1669406815
Name:FAMILY SERVICE AGENCY OF SAN MATEO COUNTY
Entity type:Organization
Organization Name:FAMILY SERVICE AGENCY OF SAN MATEO COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WISHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:650-403-4300
Mailing Address - Street 1:24 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3828
Mailing Address - Country:US
Mailing Address - Phone:650-403-4300
Mailing Address - Fax:650-403-4305
Practice Address - Street 1:2600 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3402
Practice Address - Country:US
Practice Address - Phone:650-780-7541
Practice Address - Fax:650-701-0856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ398386507010856OtherUNSURE
CAZZZ398386507010856OtherUNSURE