Provider Demographics
NPI:1215029079
Name:COUNTY OF SAN MATEO
Entity type:Organization
Organization Name:COUNTY OF SAN MATEO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-573-2748
Mailing Address - Street 1:199 CHURCHILL AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1151
Mailing Address - Country:US
Mailing Address - Phone:650-364-8186
Mailing Address - Fax:
Practice Address - Street 1:199 CHURCHILL AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:CA
Practice Address - Zip Code:94062-1151
Practice Address - Country:US
Practice Address - Phone:650-364-8186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN MATEO COUNTY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-29
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80499ZMedicare PIN