Provider Demographics
NPI:1023105244
Name:MARIN COUNTY COMMUNITY MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:MARIN COUNTY COMMUNITY MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGY INTERN
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CRAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:415-499-7594
Mailing Address - Street 1:1800 BROADWAY APT 202
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-2232
Mailing Address - Country:US
Mailing Address - Phone:415-440-4606
Mailing Address - Fax:
Practice Address - Street 1:161 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2068
Practice Address - Country:US
Practice Address - Phone:415-499-7594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare