| Spread Your Wings For Mental Health Inc | |
|
570 Blossom Hill Rd San Jose CA 95123-3212 | |
| (855) 799-4647 | |
| Not Available |
| Full Name | Spread Your Wings For Mental Health Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 570 Blossom Hill Rd, San Jose, California |
| Authorized Official Name and Position | Andrew Serry Dumbuya (CEO) |
| Authorized Official Contact | 4084012984 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spread Your Wings For Mental Health Inc 570 Blossom Hill Rd San Jose CA 95123-3212 Ph: (855) 799-4647 | Spread Your Wings For Mental Health Inc 570 Blossom Hill Rd San Jose CA 95123-3212 Ph: (855) 799-4647 |
| NPI Number | 1760969539 |
|---|---|
| Provider Enumeration Date | 07/25/2018 |
| Last Update Date | 10/22/2021 |
| Certification Date | 10/22/2021 |
| Medicare PECOS PAC ID | 1355680273 |
|---|---|
| Medicare Enrollment ID | O20190311001711 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760969539 | NPI | - | NPPES |
| CA336219 | Other | CA | CA MEDICARE |
| Provider Name | Tiffany Sarrach |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1730382169 PECOS PAC ID: 9335370717 Enrollment ID: I20140327002234 |
| Provider Name | Vivian Wesley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093190498 PECOS PAC ID: 4082043070 Enrollment ID: I20200325003829 |
| Provider Name | Kelsey Shawn Keane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174017131 PECOS PAC ID: 8820486244 Enrollment ID: I20211103002202 |
| Provider Name | Jeanette M Gibson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073233714 PECOS PAC ID: 3274918024 Enrollment ID: I20220915001630 |
| Provider Name | Wen Fan |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1932486172 PECOS PAC ID: 4789029356 Enrollment ID: I20240305002997 |
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