Provider Demographics
NPI:1093252843
Name:JESUIT INSTITUTE FOR FAMILY LIFE
Entity Type:Organization
Organization Name:JESUIT INSTITUTE FOR FAMILY LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENCE MARRIAGE FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT 12904
Authorized Official - Phone:650-343-0114
Mailing Address - Street 1:300 MANRESA WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-4569
Mailing Address - Country:US
Mailing Address - Phone:650-948-4854
Mailing Address - Fax:650-948-0640
Practice Address - Street 1:300 MANRESA WAY
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-4569
Practice Address - Country:US
Practice Address - Phone:650-948-4854
Practice Address - Fax:650-948-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251V00000XCHARITABLE251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable