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General NPI Number Information
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NPI Number | 1962967208
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Entity Type | Organization
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Legal Business Name | BAY AREA MINDS MARRIAGE AND FAMILY THERAPY, INC
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Dates
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Enumeration Date | 01/31/2019
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 1460 MARIA LN STE 310
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City | WALNUT CREEK
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State | CA
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Zip | 94596-8803
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Country | US
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Telephone | 925-878-9260
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Fax | 925-299-1928
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Provider Business Mailing Address
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Address Line | PO BOX 623
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City | LAFAYETTE
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State | CA
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Zip | 94549-0623
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Country | US
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Telephone | 925-878-9260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIA DI RIENZO
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Credential | LMFT
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Telephone | 925-878-9260
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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 |
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License Number State |
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