Provider Demographics
NPI:1730721929
Name:SAN MATEO COUNTY
Entity type:Organization
Organization Name:SAN MATEO COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HUMAN SERVICES MANAGER II
Authorized Official - Prefix:MS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURBONNAIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:650-802-6583
Mailing Address - Street 1:1 DAVIS DRIVE
Mailing Address - Street 2:ATTN: NATASHA BOURBONNAIS
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002
Mailing Address - Country:US
Mailing Address - Phone:650-802-6583
Mailing Address - Fax:650-592-3056
Practice Address - Street 1:31 TOWER RD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-4000
Practice Address - Country:US
Practice Address - Phone:650-312-5320
Practice Address - Fax:650-572-2414
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF SAN MATEO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-09
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children