Provider Demographics
NPI:1063044535
Name:GRACE JEBARA MARRIAGE THERAPY INC
Entity Type:Organization
Organization Name:GRACE JEBARA MARRIAGE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANOTAS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:415-891-9562
Mailing Address - Street 1:6 SNOWDEN LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1029
Mailing Address - Country:US
Mailing Address - Phone:415-891-9562
Mailing Address - Fax:
Practice Address - Street 1:2169 UNION ST # 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4003
Practice Address - Country:US
Practice Address - Phone:415-891-9562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty