Organization
WEST COAST POSTTRAUMA RETREAT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEL FAY PSY.D. (PRESIDENT)
(415) 720-6653
Entity
Organization
Contact information
Practice address
4460 - 16 REDWOOD HWY, SUITE 362, SAN RAFAEL, CA 94903-1953
(415) 721-9789
Mailing address
4460 - 16 REDWOOD HWY, SUITE 362, SAN RAFAEL, CA 94903-1953
(415) 721-9789
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
PSY 18339
CA
Other
Enumeration date
07/09/2006
Last updated
08/22/2020
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