Provider Demographics
NPI:1710495841
Name:CARY ANN ROSKO, A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:CARY ANN ROSKO, A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:CARY ANN ROSKO PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROSKO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-689-8591
Mailing Address - Street 1:2443 FILLMORE ST # 38017539
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1814
Mailing Address - Country:US
Mailing Address - Phone:415-689-8591
Mailing Address - Fax:
Practice Address - Street 1:3884 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3839
Practice Address - Country:US
Practice Address - Phone:415-689-8591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96606261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)