Healthcare Provider Details

I. General information

NPI: 1568222859
Provider Name (Legal Business Name): JEWISH FAMILY AND CHILDREN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 5TH AVE
SAN RAFAEL CA
94901-3348
US

IV. Provider business mailing address

600 5TH AVE
SAN RAFAEL CA
94901-3348
US

V. Phone/Fax

Practice location:
  • Phone: 415-419-3608
  • Fax: 415-755-1716
Mailing address:
  • Phone: 415-419-3608
  • Fax: 415-755-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER TRIPATHY
Title or Position: PROGRAM DIRECTOR
Credential: MFT
Phone: 415-419-3608