Healthcare Provider Details

I. General information

NPI: 1316394422
Provider Name (Legal Business Name): MARIN FAMILY THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PROFESSIONAL CENTER DR STE 322
NOVATO CA
94947-4334
US

IV. Provider business mailing address

300 PROFESSIONAL CENTER DR STE 322
NOVATO CA
94947-4334
US

V. Phone/Fax

Practice location:
  • Phone: 415-892-0764
  • Fax: 415-898-3414
Mailing address:
  • Phone: 415-892-0764
  • Fax: 415-898-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. ROSLYN M SCHWARTZ
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 415-892-0764