Healthcare Provider Details

I. General information

NPI: 1609917236
Provider Name (Legal Business Name): MARSHA VAUGHN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 A ST
SAN RAFAEL CA
94901-3011
US

IV. Provider business mailing address

PO BOX 3517
SAN RAFAEL CA
94912-3517
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-8182
  • Fax: 415-457-7471
Mailing address:
  • Phone: 415-457-8182
  • Fax: 415-457-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: