MEDICARE: PAULINE SANDRA JARAKIAN MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT36982	CA

General Provider Information

NPI Number	:	1538367867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULINE SANDRA JARAKIAN MFT

Provider Business Mailing Address
First Line	:	202 KENT AVE
Second Line	:	APARTMENT 20
City	:	KENTFIELD
State	:	CA
Zip	:	94904-2552
Country	:	US
Telephone Number	:	510-287-9226
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 HILLTOP MALL RD
Second Line	:	SUITE 4
City	:	RICHMOND
State	:	CA
Zip	:	94806-1921
Country	:	US
Telephone Number	:	510-287-9226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2007
Last Update Date	:	07/09/2007

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