Provider Demographics
NPI:1366012783
Name:AMRITA FAMILY THERAPY
Entity Type:Organization
Organization Name:AMRITA FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:NORMANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-342-5082
Mailing Address - Street 1:30 N SAN PEDRO RD STE 265
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4153
Mailing Address - Country:US
Mailing Address - Phone:415-570-2270
Mailing Address - Fax:
Practice Address - Street 1:30 N SAN PEDRO RD STE 265
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4153
Practice Address - Country:US
Practice Address - Phone:415-570-2270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)