Provider Demographics
NPI:1174987119
Name:HEAL PSYCHIATRIC SERVICES, INC
Entity type:Organization
Organization Name:HEAL PSYCHIATRIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-273-4082
Mailing Address - Street 1:1710 S AMPHLETT BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2703
Mailing Address - Country:US
Mailing Address - Phone:650-273-4082
Mailing Address - Fax:650-275-7559
Practice Address - Street 1:1710 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2703
Practice Address - Country:US
Practice Address - Phone:650-273-4082
Practice Address - Fax:650-275-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2016-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA950332084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty