Provider Demographics
NPI:1952532053
Name:MOUNT SAINT JOSEPH AND ELIZABETH
Entity type:Organization
Organization Name:MOUNT SAINT JOSEPH AND ELIZABETH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFTI
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:510-251-1033
Mailing Address - Street 1:100 MASONIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-4415
Mailing Address - Country:US
Mailing Address - Phone:415-567-8370
Mailing Address - Fax:
Practice Address - Street 1:100 MASONIC AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-4415
Practice Address - Country:US
Practice Address - Phone:415-567-8370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952449316OtherMEDICAL
CA1952449316OtherMEDICAL