Provider Demographics
NPI:1689938458
Name:CENTER ON JUVENILE AND CRIMINAL JUSTICE
Entity Type:Organization
Organization Name:CENTER ON JUVENILE AND CRIMINAL JUSTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:HITCHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-424-2543
Mailing Address - Street 1:40 BOARDMAN PL
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-4729
Mailing Address - Country:US
Mailing Address - Phone:951-258-3561
Mailing Address - Fax:
Practice Address - Street 1:40 BOARDMAN PL
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-4729
Practice Address - Country:US
Practice Address - Phone:951-258-3561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD6347788251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health