Healthcare Provider Details

I. General information

NPI: 1558430900
Provider Name (Legal Business Name): JOYCE AILSON KERMEEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 VAN NESS AVE STE 503
SAN FRANCISCO CA
94109-7893
US

IV. Provider business mailing address

4104 24TH ST # 521
SAN FRANCISCO CA
94114-3676
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-7766
  • Fax: 415-775-7730
Mailing address:
  • Phone: 415-775-7766
  • Fax: 415-775-7730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 39979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: