Organization
CHILD THERAPY INSTITUTE OF MARIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN LUKAS PHD (EXECUTIVE DIRECTOR)
(415) 456-7724
Entity
Organization
Contact information
Practice address
240 TAMAL VISTA BLVD, #155, CORTE MADERA, CA 94925-1132
(415) 456-7724
(415) 456-1050
Mailing address
1480 LINCOLN AVE, #8, SAN RAFAEL, CA 94901-2084
(415) 456-7724
(415) 456-1050
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
03/23/2017
Last updated
03/23/2017
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