Healthcare Provider Details

I. General information

NPI: 1083101711
Provider Name (Legal Business Name): CONNECTIVE FAMILY THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 07/16/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

870 MARKET ST STE 345
SAN FRANCISCO CA
94102-3022
US

IV. Provider business mailing address

870 MARKET ST STE 345
SAN FRANCISCO CA
94102-3022
US

V. Phone/Fax

Practice location:
  • Phone: 415-632-1010
  • Fax: 415-632-1010
Mailing address:
  • Phone: 415-632-1010
  • Fax: 415-632-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. TARA DANIELLE BAKER
Title or Position: OWNER
Credential: LMFT
Phone: 415-632-1010