Basic Information
Provider Information
NPI: 1003004045
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LANDO
FirstName: JOAN
MiddleName: L
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 802 BREWSTER AVE
Address2:  
City: REDWOOD CITY
State: CA
PostalCode: 940631510
CountryCode: US
TelephoneNumber: 6503634111
FaxNumber:  
Practice Location
Address1: 802 BREWSTER AVE
Address2:  
City: REDWOOD CITY
State: CA
PostalCode: 940631510
CountryCode: US
TelephoneNumber: 6503634111
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/03/2007
LastUpdateDate: 09/22/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041S0200X  Y Behavioral Health & Social Service ProvidersSocial WorkerSchool

No ID Information.


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