Provider Demographics
NPI:1033003371
Name:COOGAN, MARTHA LYNN (AMFT)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYNN
Last Name:COOGAN
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 ROUNDTREE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1649
Mailing Address - Country:US
Mailing Address - Phone:415-595-0047
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND ST STE 108
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2701
Practice Address - Country:US
Practice Address - Phone:415-339-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142750106H00000X
CA14744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health