Provider Demographics
NPI:1417580044
Name:RD FAMILY THERAPY INC.
Entity Type:Organization
Organization Name:RD FAMILY THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RYANN
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:DESOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:650-720-5263
Mailing Address - Street 1:1150 BRICKYARD COVE RD UNIT B12
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-4181
Mailing Address - Country:US
Mailing Address - Phone:650-720-5263
Mailing Address - Fax:510-788-5044
Practice Address - Street 1:1150 BRICKYARD COVE RD UNIT B12
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4181
Practice Address - Country:US
Practice Address - Phone:650-720-5263
Practice Address - Fax:510-788-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043493042OtherOTHER INSURERS