MEDICARE: FAMILY WORKS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1548449606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY WORKS

Provider Business Mailing Address
First Line	:	4 JOSEPH CT
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2609
Country	:	US
Telephone Number	:	415-492-0720
Fax Number	:	415-492-1099

Provider Business Practice Location Address
First Line	:	4 JOSEPH CT
Second Line	:
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2609
Country	:	US
Telephone Number	:	415-492-0720
Fax Number	:	415-492-1099

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. MICHAEL DIEHL
Credential	:
Telephone Number	:	415-492-0720

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	11/28/2016

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Directions to “FAMILY WORKS ” Practice Location

Language	Start Address	Practice Location

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