Provider Demographics
NPI:1750825360
Name:MINDFIT FAMILY THERAPY
Entity Type:Organization
Organization Name:MINDFIT FAMILY THERAPY
Other - Org Name:CENTER FOR INNOVATIVE DBT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAZZA FRANCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-339-8001
Mailing Address - Street 1:45 SAN CLEMENTE DR
Mailing Address - Street 2:C200
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1244
Mailing Address - Country:US
Mailing Address - Phone:415-339-8001
Mailing Address - Fax:
Practice Address - Street 1:45 SAN CLEMENTE DR
Practice Address - Street 2:C200
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1244
Practice Address - Country:US
Practice Address - Phone:415-339-8001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39319106H00000X
CA88916106H00000X
CA89889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty