1912116252 NPI number — COUNTY OF MARIN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912116252 NPI number — COUNTY OF MARIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MARIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MENTAL HEALTH AND SUBSTANCE USE SERVICES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912116252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 N SAN PEDRO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN RAFAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94903-4188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-473-6948
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 N SAN PEDRO RD
Provider Second Line Business Practice Location Address:
SUITES 1015, 1018, 1019
Provider Business Practice Location Address City Name:
SAN RAFAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94903-4178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-473-3030
Provider Business Practice Location Address Fax Number:
415-473-7008
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LALLANA
Authorized Official First Name:
ROSANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPLIANCE PRIVACY SECURITY OFCR
Authorized Official Telephone Number:
415-473-2531

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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