Healthcare Provider Details

I. General information

NPI: 1538781190
Provider Name (Legal Business Name): CIFC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2020
Last Update Date: 05/17/2020
Certification Date: 05/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 CONGRESS ST STE 2C
SAN DIEGO CA
92110-2767
US

IV. Provider business mailing address

2725 CONGRESS ST STE 2C
SAN DIEGO CA
92110-2767
US

V. Phone/Fax

Practice location:
  • Phone: 618-688-1035
  • Fax: 619-688-1098
Mailing address:
  • Phone: 618-688-1035
  • Fax: 619-688-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELE SUZANNE KOONIN
Title or Position: DIRECTOR
Credential: LCSW, MBA
Phone: 619-496-7822