Provider Demographics
NPI:1164915112
Name:FAMILY RECOVERY INSTITUTE
Entity Type:Organization
Organization Name:FAMILY RECOVERY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:PERLMUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-322-0939
Mailing Address - Street 1:1800 LINCOLN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-322-0939
Mailing Address - Fax:415-448-5309
Practice Address - Street 1:1800 LINCOLN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-322-0939
Practice Address - Fax:415-448-5309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty