Organization
CHILD THERAPY INSTITUTE OF MARIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN LUKAS (EXECUTIVE DIRECTOR)
(415) 456-7724
Entity
Organization
Contact information
Practice address
92 LOUISE STREET, SAN RAFAEL, CA 94901
(415) 456-7724
Mailing address
1480 LINCOLN AVE., #8, SAN RAFAEL, CA 94901
(415) 456-7724
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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