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General NPI Number Information
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NPI Number | 1790236230
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Entity Type | Organization
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Legal Business Name | MARRIAGE & FAMILY THERAPY ASSOCIATES
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 3 SOUTH STREET SUITE 300
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City | AUBURN
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State | NY
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Zip | 13021-9519
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Country | US
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Telephone | 315-282-7076
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SOUTH STREET SUITE 300
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City | AUBURN
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State | NY
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Zip | 13021-9519
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Country | US
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Telephone | 315-282-7076
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Fax |
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Authorized Official
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Title or Position | SENIOR STAFF THERAPIST
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Name | MS. BRANDI DANIELLE MACK
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Credential | MA-MFT, LMFT
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Telephone | 315-282-7076
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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 | 000918
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License Number State | NY
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