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2290 14th Ave San Francisco CA 94116-1841 | |
| (415) 776-1001 | |
| (415) 776-1066 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 2290 14th Ave, San Francisco, California |
| Authorized Official Name and Position | Vitka Eisen (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4157621558 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1735 Mission St San Francisco CA 94103-2417 Ph: (415) 762-3712 | 2290 14th Ave San Francisco CA 94116-1841 Ph: (415) 776-1001 |
| NPI Number | 1295092815 |
|---|---|
| Provider Enumeration Date | 04/20/2012 |
| Last Update Date | 01/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295092815 | NPI | - | NPPES |
| 38IG | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
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