Healthcare Provider Details

I. General information

NPI: 1326279183
Provider Name (Legal Business Name): CATHERINE E. MAIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 TAMAL VISTA BLVD SUITE 270
CORTE MADERA CA
94925-1132
US

IV. Provider business mailing address

240 TAMAL VISTA BLVD SUITE 270
CORTE MADERA CA
94925-1132
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-0424
  • Fax: 415-388-7371
Mailing address:
  • Phone: 415-457-0424
  • Fax: 415-388-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY13384
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY13384
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13384
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY13384
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY13384
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY13384
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY13384
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPSY13384
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY13384
License Number StateCA

VIII. Authorized Official

Name: DR. CATHERINE E. MAIN
Title or Position: PRESIDENT
Credential: PH. D.
Phone: 415-457-0424