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General NPI Number Information
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NPI Number | 1154776516
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Entity Type | Organization
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Legal Business Name | DBT PSYCHOLOGY CENTER OF MARIN, PC
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 895 SIR FRANCIS DRAKE BLVD
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City | SAN ANSELMO
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State | CA
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Zip | 94960-1916
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Country | US
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Telephone | 415-699-7464
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Fax |
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Provider Business Mailing Address
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Address Line | 895 SIR FRANCIS DRAKE BLVD
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City | SAN ANSELMO
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State | CA
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Zip | 94960-1916
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Country | US
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Telephone | 415-699-7464
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ALICIA SMART
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Credential | PSYD
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Telephone | 415-459-5206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY24516
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License Number State | CA
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