Provider Demographics
NPI:1790236230
Name:MARRIAGE & FAMILY THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:MARRIAGE & FAMILY THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR STAFF THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:MA-MFT, LMFT
Authorized Official - Phone:315-282-7076
Mailing Address - Street 1:3 SOUTH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9519
Mailing Address - Country:US
Mailing Address - Phone:315-282-7076
Mailing Address - Fax:
Practice Address - Street 1:3 SOUTH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-9519
Practice Address - Country:US
Practice Address - Phone:315-282-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty