Provider Demographics
NPI:1891820577
Name:COUNTY OF MARIN COMMUNITY MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:COUNTY OF MARIN COMMUNITY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE/PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALLANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-473-2531
Mailing Address - Street 1:20 N SAN PEDRO RD STE 2021
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4158
Mailing Address - Country:US
Mailing Address - Phone:415-499-6769
Mailing Address - Fax:415-499-4283
Practice Address - Street 1:20 N SAN PEDRO RD STE 2021
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4158
Practice Address - Country:US
Practice Address - Phone:415-499-6769
Practice Address - Fax:415-499-4283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000002177Medicaid
CA000002177Medicaid
CA000002177Medicaid