Healthcare Provider Details

I. General information

NPI: 1609174044
Provider Name (Legal Business Name): SHOSHANA KOBRIN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2011
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 QUAIL CT #200
WALNUT CREEK CA
94596-5566
US

IV. Provider business mailing address

1232 RUNNING SPRINGS RD #3
WALNUT CREEK CA
94595-5242
US

V. Phone/Fax

Practice location:
  • Phone: 925-256-8503
  • Fax: 925-256-8503
Mailing address:
  • Phone: 925-256-8503
  • Fax: 925-256-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT 23716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: