CHILD THERAPY INSTITUTE OF MARIN (NPI# 1154713774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154713774 |
| Entity Type | Organization |
| Organization Name | CHILD THERAPY INSTITUTE OF MARIN |
| Practice Address |
720 Southpoint Blvd Petaluma CA 94954-7495 |
| Mailing Address |
1480 Lincoln Ave Ste 8 San Rafael CA 94901-2085 |
| Practice Telephone | 7072373644 |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2015-02-19 |
| Authorized Official Name | DR. BRIAN N LUKAS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4154567724 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073074324 | Child Therapy Institute of Marin | Community/Behavioral Health | 3195 California St Ste D, San Francisco, CA 94115-2412 | 2019-03-28 |
| 1760891931 | Child Therapy Institute of Marin | Clinic/Center | 2300 Martin Luther King Jr Way, Resource Room, Berkeley, CA 94704-1412 | 2014-08-12 |
| 1487092144 | Child Therapy Institute of Marin | Community/Behavioral Health | 2015 Virginia St, Berkeley, CA 94709-2229 | 2013-06-04 |
| 1265790489 | Child Therapy Institute of Marin | Community/Behavioral Health | 92 Louise Street, San Rafael, CA 94901 | 2012-04-25 |
| 1619014081 | Child Therapy Institute of Marin | Clinic/Center | 1480 Lincoln Ave Ste 8, San Rafael, CA 94901-2085 | 2007-02-01 |
| 1821633348 | Child Therapy Institute of Marin | Marriage & Family Therapist | 558 San Anselmo Ave, San Anselmo, CA 94960-2621 | 2019-11-07 |
| 1134641731 | Child Therapy Institute of Marin | Clinic/Center | 11100 San Pablo Ave Ste 205, El Cerrito, CA 94530-2100 | 2017-07-14 |
| 1790216489 | Child Therapy Institute of Marin | Community/Behavioral Health | 240 Tamal Vista Blvd, #155, Corte Madera, CA 94925-1132 | 2017-03-23 |
| 1801256300 | Child Therapy Institute of Marin | Community/Behavioral Health | 700 E St, San Rafael, CA 94901-2762 | 2016-02-26 |
| 1497935308 | Child Therapy Institute of Marin | Community/Behavioral Health | 2926 Lone Tree Way, Antioch, CA 94509-4924 | 2007-11-07 |
| Street Address |
720 SOUTHPOINT BLVD |
| City | PETALUMA |
| State | CA |
| Zip Code | 94954-7495 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659418770 | Iverson M. Eicken | Psychologist | 720 Southpoint Blvd, Suite 202, Petaluma, CA 94954-7495 | 2007-01-30 |
| 1598103145 | Patricia T Hromalik | Marriage & Family Therapist | 720 Southpoint Blvd, Suite 212b, Petaluma, CA 94954-7495 | 2013-06-05 |
| 1265670103 | Tony L. Johnson | Marriage & Family Therapist | 720 Southpoint Blvd, Suite 202, Petaluma, CA 94954-7495 | 2009-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346883840 | Miguel Ibarra | Counselor | 5350 Old Redwood Highway, Petaluma, CA 94954 | 2019-10-28 |
| 1073169223 | Monica Renee Najera | Behavior Technician | 1670 Corporate Circle, Ste. 100, Petaluma, CA 94954 | 2019-08-14 |
| 1326607201 | Making Magic Happen - People Helping People, Inc. | Marriage & Family Therapist | 1318 Redwood Way, Suite 260, Petaluma, CA 94954 | 2019-06-13 |
| 1477019917 | Rubi Isela Cruz Mendoza I | Behavioral Analyst | 8 Round Walk Circle, Petaluma, CA 94954 | 2019-02-20 |
| 1932679511 | Karen Christianson | Behavior Technician | 1670 Corporate Circle Suite 100, Petaluma, CA 94954 | 2018-11-27 |
| 1669956967 | Alyssa Messer | Assistant Behavior Analyst | 1670 Corporate Cir, Petaluma, CA 94954 | 2018-09-21 |
| 1235620592 | Mallory Paige Mullikin | Nurse Practitioner | 141 Lynch Creek Trail, Ste C, Petaluma, CA 94954 | 2018-05-22 |
| 1457723710 | Lisabel Dolne | Counselor | 1360 N. Mcdowell Blvd.1a, Petaluma, CA 94954 | 2015-10-27 |
| 1083080717 | Pacific Restorative Center | Clinic/Center | 1456 Professional Drive, Suite 404, Petaluma, CA 94954 | 2015-08-17 |
| 1619354198 | Accu Quest Hearing Centers | Clinic/Center | 1456 Professional Dr., Suite 404, Petaluma, CA 94954 | 2015-05-04 |
| Find all providers in zip 94954 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851744122 | Mothers Care | Clinic/Center | 205 Keller St Ste 201, Petaluma, CA 94952-2886 | 2016-07-21 |
| 1295949733 | County of Sonoma | Clinic/Center | 5350 Old Redwood Hwy N, Suite 600, Petaluma, CA 94954-1115 | 2007-05-10 |
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| 1962016527 | Los Angeles County Department of Mental Health | Clinic/Center | 2934 E Garvey Ave South Ste 230, West Covina, CA 91791-6101 | 2020-09-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.