Healthcare Provider Details

I. General information

NPI: 1477972057
Provider Name (Legal Business Name): MARIANA PRUTTON M.S., LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 MISSION ST # 311
SAN FRANCISCO CA
94110-4501
US

IV. Provider business mailing address

3041 MISSION ST # 311
SAN FRANCISCO CA
94110-4501
US

V. Phone/Fax

Practice location:
  • Phone: 415-963-4149
  • Fax:
Mailing address:
  • Phone: 415-963-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number105661
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: