Provider Demographics
NPI:1831217546
Name:TAYLOR, ANNETTE M (MFT)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1521
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-6521
Mailing Address - Country:US
Mailing Address - Phone:415-509-2906
Mailing Address - Fax:650-355-7134
Practice Address - Street 1:450 DONDEE WAY, SUITE 13
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044
Practice Address - Country:US
Practice Address - Phone:415-509-2906
Practice Address - Fax:650-355-7134
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC 46271OtherBOARD OF BEHAVIORAL SCIENCES
CA52047Medicare PIN