Provider Demographics
NPI:1811395270
Name:NERINA M. CECCHIN
Entity Type:Organization
Organization Name:NERINA M. CECCHIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NERINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CECCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:415-300-7922
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94914-0642
Mailing Address - Country:US
Mailing Address - Phone:415-300-7922
Mailing Address - Fax:
Practice Address - Street 1:1368 LINCOLN AVE STE 212
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2121
Practice Address - Country:US
Practice Address - Phone:415-300-7922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT #51817251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management