Healthcare Provider Details

I. General information

NPI: 1760186191
Provider Name (Legal Business Name): FIRST 5 MARIN CHILDREN AND FAMILIES COMMISSION/HELP ME GROW MARIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 NORTGHGATE DRIVE, SUITE 130
SAN RAFAEL CA
94903
US

IV. Provider business mailing address

1050 NORTHGATE DR STE 130
SAN RAFAEL CA
94903-2557
US

V. Phone/Fax

Practice location:
  • Phone: 415-720-1283
  • Fax:
Mailing address:
  • Phone: 415-720-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSANNE R KREUZER
Title or Position: MANAGER/CHILD DEVELOPMENT SPECIALIS
Credential: MS;CTRS
Phone: 415-720-1283