Healthcare Provider Details

I. General information

NPI: 1497170088
Provider Name (Legal Business Name): DR. MICHAEL SZYMANSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 KERNER BLVD STE A SAN RAFAEL, CA 94901
SAN RAFAEL CA
94901-4840
US

IV. Provider business mailing address

9 SANTA GABRIELLA CT
NOVATO CA
94945-1121
US

V. Phone/Fax

Practice location:
  • Phone: 415-456-9350
  • Fax: 415-456-1508
Mailing address:
  • Phone: 415-913-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: