Healthcare Provider Details

I. General information

NPI: 1669533733
Provider Name (Legal Business Name): CAROL JEANINE URBAN M.ED., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 TURK ST
SAN FRANCISCO CA
94102-3118
US

IV. Provider business mailing address

1656 POWELL STREET #111
SAN FRANCISCO CA
94133
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-0266
  • Fax: 415-353-5032
Mailing address:
  • Phone: 415-353-0266
  • Fax: 415-353-5032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFCC 43629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: