Healthcare Provider Details

I. General information

NPI: 1922464445
Provider Name (Legal Business Name): MARIN PSYCHIATRIC GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD MARIN GENERAL HOSPITAL, UNIT A, BEHAVIORAL HEALTH
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

706 SAN ANSELMO AVE # 137
SAN ANSELMO CA
94960-2618
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-8808
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN C. ALLISON
Title or Position: CFO
Credential: M.D.
Phone: 415-952-3101