Provider Demographics
NPI:1952969743
Name:SUPPORT NETWORK OF THE BAY AREA
Entity Type:Organization
Organization Name:SUPPORT NETWORK OF THE BAY AREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:NEWSOME
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:415-999-5613
Mailing Address - Street 1:293 SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1129
Mailing Address - Country:US
Mailing Address - Phone:415-999-5613
Mailing Address - Fax:
Practice Address - Street 1:293 SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1129
Practice Address - Country:US
Practice Address - Phone:415-999-5613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty