Provider Demographics
NPI:1578972766
Name:CONNECT2 MARRIAGE COUNSELING, INC.
Entity Type:Organization
Organization Name:CONNECT2 MARRIAGE COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHANDRAMA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MFT
Authorized Official - Phone:650-847-0030
Mailing Address - Street 1:420 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1802
Mailing Address - Country:US
Mailing Address - Phone:650-847-0030
Mailing Address - Fax:
Practice Address - Street 1:667 LYTTON AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1335
Practice Address - Country:US
Practice Address - Phone:650-847-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45204106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty