Provider Demographics
NPI:1649037128
Name:MARIANA PRUTTON
Entity type:Organization
Organization Name:MARIANA PRUTTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-604-3509
Mailing Address - Street 1:3041 MISSION ST # 311
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4501
Mailing Address - Country:US
Mailing Address - Phone:415-604-3509
Mailing Address - Fax:
Practice Address - Street 1:1640 VALENCIA ST STE 2B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5040
Practice Address - Country:US
Practice Address - Phone:415-604-3509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)