| Square Peg Foundation | |
|
12150 San Mateo Rd Half Moon Bay CA 94019-7108 | |
| (650) 440-5064 | |
| Not Available |
| Full Name | Square Peg Foundation |
|---|---|
| Speciality | Behavior Analyst |
| Location | 12150 San Mateo Rd, Half Moon Bay, California |
| Authorized Official Name and Position | Joell Marie Dunlap (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6504405064 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Square Peg Foundation 80 Cabrillo Hwy N Ste Q Pmb 402 Half Moon Bay CA 94019-1698 Ph: (650) 440-5064 | Square Peg Foundation 12150 San Mateo Rd Half Moon Bay CA 94019-7108 Ph: (650) 440-5064 |
| NPI Number | 1609228840 |
|---|---|
| Provider Enumeration Date | 07/12/2016 |
| Last Update Date | 07/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609228840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | BCBA 1-14-15647 (California) | Primary |
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