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Provider Information for 1518681584


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EVETTE LOUHISDON


Sex: Female

NPI: 1518681584
Last Updated: 2023-08-30
Certification Date: 2023-08-30

Details

NameValue
NPI1518681584
Enumeration Date2022-10-03
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 990 VILLA ST
MOUNTAIN VIEW, CA 94041-1236
United States

Phone: 786-383-3730 | Fax:
 
Primary Practice Address 990 VILLA ST
MOUNTAIN VIEW, CA 94041-1236
United States

Phone: 772-359-1759 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDNY3535
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 1041C0700X - Social Worker - ClinicalNY
Yes 1041C0700X - Social Worker - ClinicalNY0347701