Provider Demographics
NPI:1851626501
Name:ENGEBRECHT, RICHARD ERWIN JR (MFT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ERWIN
Last Name:ENGEBRECHT
Suffix:JR
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 LINCOLN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2141
Mailing Address - Country:US
Mailing Address - Phone:415-289-7001
Mailing Address - Fax:415-663-4183
Practice Address - Street 1:1330 LINCOLN AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2141
Practice Address - Country:US
Practice Address - Phone:415-289-7001
Practice Address - Fax:415-663-4183
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist