Healthcare Provider Details

I. General information

NPI: 1841162211
Provider Name (Legal Business Name): PARENT SERVICES PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 BELVEDERE ST STE 101
SAN RAFAEL CA
94901-4868
US

IV. Provider business mailing address

79 BELVEDERE ST STE 101
SAN RAFAEL CA
94901-4868
US

V. Phone/Fax

Practice location:
  • Phone: 415-454-1870
  • Fax:
Mailing address:
  • Phone: 415-454-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. BALANDRA FREGOSO
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 415-497-7472