Provider Demographics
NPI:1902933476
Name:KAISER SANTA THERESA PSYCHIATRY DEPT
Entity Type:Organization
Organization Name:KAISER SANTA THERESA PSYCHIATRY DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:B
Authorized Official - Last Name:MICHELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-972-3419
Mailing Address - Street 1:P O BOX 5956
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150
Mailing Address - Country:US
Mailing Address - Phone:408-972-3419
Mailing Address - Fax:
Practice Address - Street 1:5755 COTTLE RD
Practice Address - Street 2:BUILDING 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-972-3419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS21247302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization