Provider Demographics
NPI:1831274380
Name:OMACHI, MARCIA SPECTOR (LCSW)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:SPECTOR
Last Name:OMACHI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:SPECTOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:60 EL VERANO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2037
Mailing Address - Country:US
Mailing Address - Phone:415-970-3884
Mailing Address - Fax:415-970-3813
Practice Address - Street 1:3801 3RD ST
Practice Address - Street 2:SUITE 400 FCMHP
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-1409
Practice Address - Country:US
Practice Address - Phone:415-970-3884
Practice Address - Fax:415-970-3813
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13942103TC0700X
CALCS71761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical