1831274380 NPI number — DR. MARCIA SPECTOR OMACHI LCSW

Table of content: DR. MARCIA SPECTOR OMACHI LCSW (NPI 1831274380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831274380 NPI number — DR. MARCIA SPECTOR OMACHI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OMACHI
Provider First Name:
MARCIA
Provider Middle Name:
SPECTOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SPECTOR
Provider Other First Name:
MARCIA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831274380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 EL VERANO WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94127-2037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-970-3884
Provider Business Mailing Address Fax Number:
415-970-3813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 400 FCMHP
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94124-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-970-3884
Provider Business Practice Location Address Fax Number:
415-970-3813
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY13942 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS7176 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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