Provider Demographics
NPI:1972655678
Name:FAMILY SERVICE AGENCY OF MARIN
Entity Type:Organization
Organization Name:FAMILY SERVICE AGENCY OF MARIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUFFRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:415-491-5700
Mailing Address - Street 1:555 NORTHGATE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3680
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:384 PANORAMIC HWY
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2646
Practice Address - Country:US
Practice Address - Phone:415-888-3384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health