Provider Demographics
NPI:1518179175
Name:MILES, CLAUDIA S (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:CLAUDIA
Middle Name:S
Last Name:MILES
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 C ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4919
Mailing Address - Country:US
Mailing Address - Phone:415-460-9737
Mailing Address - Fax:
Practice Address - Street 1:700 E ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2762
Practice Address - Country:US
Practice Address - Phone:415-460-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38418106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA#MFC38418OtherMFT LICENSE NUMBER
CA11718473OtherCAQH ID NUMBER