Healthcare Provider Details

I. General information

NPI: 1336011048
Provider Name (Legal Business Name): SEEDS SOCIAL EMOTIONAL EDUCATION AND DEVELOPMENT OF SELF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 VILLAGE CIR
SAN RAFAEL CA
94903-4242
US

IV. Provider business mailing address

57 VILLAGE CIR
SAN RAFAEL CA
94903-4242
US

V. Phone/Fax

Practice location:
  • Phone: 510-852-2295
  • Fax:
Mailing address:
  • Phone: 510-852-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health 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. SANDRA ROBINSON
Title or Position: HUMAN RESOURCES DIRECTOR
Credential:
Phone: 845-307-0028