MEDICARE: EAST BAY INTEGRATIVE MARRIAGE AND FAMILY THERAPY GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1518897669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST BAY INTEGRATIVE MARRIAGE AND FAMILY THERAPY GROUP INC

Provider Business Mailing Address
First Line	:	707 SEA VIEW DR
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-3311
Country	:	US
Telephone Number	:	510-468-9344
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 SEA VIEW DR
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-3311
Country	:	US
Telephone Number	:	510-468-9344
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARA MARLO NICOLETTI
Credential	:	LMFT
Telephone Number	:	510-468-9344

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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