Provider Demographics
NPI:1669824777
Name:SHINE, MARIANNE H (LMFT, RDT)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:H
Last Name:SHINE
Suffix:
Gender:F
Credentials:LMFT, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HILL ST
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2006
Mailing Address - Country:US
Mailing Address - Phone:415-602-1635
Mailing Address - Fax:
Practice Address - Street 1:45 CAMINO ALTO STE 204
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2935
Practice Address - Country:US
Practice Address - Phone:415-849-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist