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General NPI Number Information
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NPI Number | 1598156796
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Entity Type | Organization
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Legal Business Name | CASA SERENA EATING DISORDERS PROGRAM SAN FRANCISCO
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 1868 CLAYTON RD SUTIE 123
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City | CONCORD
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State | CA
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Zip | 94520-2547
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Country | US
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Telephone | 925-682-8252
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Fax | 925-682-8313
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Provider Business Mailing Address
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Address Line | 3150 CALIFORNIA ST SUITE 6
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-2464
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Country | US
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Telephone | 415-757-0402
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Fax | 415-440-4402
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MISS JACQUELYN LEE HOLMES
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Credential | MFT
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Telephone | 415-757-0402
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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 | MFC25575
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License Number State | CA
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