Provider Demographics
NPI:1932856507
Name:ANCA SEVERIN MFT INC
Entity Type:Organization
Organization Name:ANCA SEVERIN MFT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:415-407-5115
Mailing Address - Street 1:1600 BRYANT ST UNIT 411461
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94141-1781
Mailing Address - Country:US
Mailing Address - Phone:415-407-5115
Mailing Address - Fax:800-807-8009
Practice Address - Street 1:1720 S AMPHLETT BLVD STE 220G
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2713
Practice Address - Country:US
Practice Address - Phone:415-407-5115
Practice Address - Fax:800-807-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty