Provider Demographics
NPI:1821708694
Name:JUDITH LUCIA I. ALBANO, A MARRIAGE AND FAMILY THERAPY CORPORATION
Entity Type:Organization
Organization Name:JUDITH LUCIA I. ALBANO, A MARRIAGE AND FAMILY THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MARRIAGE AND FAMILY THERAP
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH LUCIA
Authorized Official - Middle Name:IGNACIO
Authorized Official - Last Name:ALBANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-269-5254
Mailing Address - Street 1:55 CHICAGO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-4533
Mailing Address - Country:US
Mailing Address - Phone:415-533-5028
Mailing Address - Fax:415-480-1444
Practice Address - Street 1:80 EUREKA SQ STE 215
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2677
Practice Address - Country:US
Practice Address - Phone:415-269-5254
Practice Address - Fax:415-480-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA105832OtherLICENSE
CA105832Medicaid