Provider Demographics
NPI:1912382714
Name:MARY CHRISTY-CIRILLO MFT
Entity Type:Organization
Organization Name:MARY CHRISTY-CIRILLO MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CHRISTY-CIRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:415-613-6590
Mailing Address - Street 1:1417 BRIDGEWAY STE 6A
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1972
Mailing Address - Country:US
Mailing Address - Phone:415-613-6590
Mailing Address - Fax:
Practice Address - Street 1:1417 BRIDGEWAY STE 6A
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1972
Practice Address - Country:US
Practice Address - Phone:415-613-6590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service