1669704177 NPI number — STEPPING STONES CENTER FOR AUTISTIC SPECTRUM DISORDERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669704177 NPI number — STEPPING STONES CENTER FOR AUTISTIC SPECTRUM DISORDERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPPING STONES CENTER FOR AUTISTIC SPECTRUM DISORDERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669704177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3190 CLEARVIEW WAY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94402-3752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-357-0571
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3190 CLEARVIEW WAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94402-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-357-0571
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DAVID-NICOLAS
Authorized Official First Name:
VIVIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND CLINICAL DIRECTOR
Authorized Official Telephone Number:
650-357-0571

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1084557 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SP11976 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 1A41040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000357 . This is a "BOARD CERTIFIED BEHAVIOR ANALYST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1118412 . This is a "BOARD CERTIFIED BEHAVIOR ANALYST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 18968 . This is a "PSYD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1A41040 . This is a "NONPUBLIC AGENCY CERTIFICATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: MFC 33929 . This is a "MARRIAGE AND FAMILY THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1084557 . This is a "BOARD CERTIFIED BEHAVIOR ANALYST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1119431 . This is a "BOARD CERTIFIED BEHAVIOR ANALYST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1118273 . This is a "BOARD CERTIFIED BEHAVIOR ANALYST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: SP 11976 . This is a "SPEECH-LANGUAGE PATHOLOGIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: OT 1228 . This is a "OCCUPATIONAL THERAPIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1073329 . This is a "BOARD CERTIFIED BEHAVIOR ANALYST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 11312944 . This is a "BOARD CERTIFIED BEHAVIOR ANALYST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 20372 . This is a "PSY" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LCS 19378 . This is a "LICENSED CLINICAL SOCIAL WORKER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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