1962561704 NPI number — MS. JENNIFER MARGARET MARSH MFT

Table of content: MS. JENNIFER MARGARET MARSH MFT (NPI 1962561704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962561704 NPI number — MS. JENNIFER MARGARET MARSH MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSH
Provider First Name:
JENNIFER
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUSSELL
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
MARSH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962561704
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:
2 COMMERCIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
NOVATO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94949-6123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-883-9222
Provider Business Mailing Address Fax Number:
415-883-3014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 COMMERCIAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NOVATO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94949-6123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-883-9222
Provider Business Practice Location Address Fax Number:
415-883-3014
Provider Enumeration Date:
12/07/2006

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: 106H00000X , with the licence number:  MFC34904 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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