Healthcare Provider Details

I. General information

NPI: 1093238701
Provider Name (Legal Business Name): MARINELLA HASKINS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO STREET 6B
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1001 POTRERO AVE # 6B
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-5270
  • Fax: 415-206-4722
Mailing address:
  • Phone: 628-206-4444
  • Fax: 415-206-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number124062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: