Provider Demographics
NPI:1669704177
Name:STEPPING STONES CENTER FOR AUTISTIC SPECTRUM DISORDERS, INC.
Entity type:Organization
Organization Name:STEPPING STONES CENTER FOR AUTISTIC SPECTRUM DISORDERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID-NICOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-357-0571
Mailing Address - Street 1:3190 CLEARVIEW WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3752
Mailing Address - Country:US
Mailing Address - Phone:650-357-0571
Mailing Address - Fax:
Practice Address - Street 1:3190 CLEARVIEW WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3752
Practice Address - Country:US
Practice Address - Phone:650-357-0571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1084557103K00000X
CASP11976235Z00000X
CA1A41040252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1000357OtherBOARD CERTIFIED BEHAVIOR ANALYST
CA1118412OtherBOARD CERTIFIED BEHAVIOR ANALYST
CA18968OtherPSYD
CA1A41040OtherNONPUBLIC AGENCY CERTIFICATION
CAMFC 33929OtherMARRIAGE AND FAMILY THERAPIST
CA1084557OtherBOARD CERTIFIED BEHAVIOR ANALYST
CA1119431OtherBOARD CERTIFIED BEHAVIOR ANALYST
CA1118273OtherBOARD CERTIFIED BEHAVIOR ANALYST
CASP 11976OtherSPEECH-LANGUAGE PATHOLOGIST
CAOT 1228OtherOCCUPATIONAL THERAPIST
CA1073329OtherBOARD CERTIFIED BEHAVIOR ANALYST
CA11312944OtherBOARD CERTIFIED BEHAVIOR ANALYST
CA20372OtherPSY
CALCS 19378OtherLICENSED CLINICAL SOCIAL WORKER