Provider Demographics
NPI:1164002853
Name:LAURA FIRESTONE MARRIAGE FAMILY THERAPY, PC
Entity Type:Organization
Organization Name:LAURA FIRESTONE MARRIAGE FAMILY THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIRESTONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-343-5047
Mailing Address - Street 1:1732 FILLMORE STREET
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-343-5047
Mailing Address - Fax:
Practice Address - Street 1:1732 FILLMORE STREET
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-343-5047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty