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General NPI Number Information
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NPI Number | 1407916224
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Entity Type | Individual
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Provider Name | MARCUS H SMALL M.S.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 639 DRAKE AVE.
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City | MARIN CITY
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State | CA
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Zip | 94965
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Country | US
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Telephone | 707-322-4971
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Fax |
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Provider Business Mailing Address
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Address Line | 28 REGENTS CIR
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City | ROHNERT PARK
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State | CA
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Zip | 94928-2972
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Country | US
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Telephone | 415-491-0708
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Fax | 415-472-7140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC25851
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License Number State | CA
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