Healthcare Provider Details

I. General information

NPI: 1912431271
Provider Name (Legal Business Name): COMMUNITY ACTION MARIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 NORTHGATE DR STE 201
SAN RAFAEL CA
94903-3696
US

IV. Provider business mailing address

555 NORTHGATE DR STE 201
SAN RAFAEL CA
94903-3696
US

V. Phone/Fax

Practice location:
  • Phone: 415-526-7511
  • Fax:
Mailing address:
  • Phone: 415-526-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. CHANDRA ALEXANDRE
Title or Position: CEO
Credential:
Phone: 415-526-7511