MASONIC CENTER FOR YOUTH AND FAMILIES (NPI# 1356749279) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356749279 |
| Entity Type | Organization |
| Organization Name | MASONIC CENTER FOR YOUTH AND FAMILIES |
| Practice Address |
6 Funston Ave San Francisco CA 94129 |
| Mailing Address |
6 Funston Ave San Francisco CA 94129-1109 |
| Practice Telephone | 4159293001 |
| Mailing Telephone | 4159293001 |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2014-12-09 |
| Authorized Official Name | SUSANNA BONETTI (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Telephone | 4159293001 |
| Is Organization Subpart | Y |
| Parent Organization Name | MASONIC HOMES OF CALIFORNIA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
550001484 | CA | Ambulatory Health Care Facilities |
| Street Address |
6 FUNSTON AVE |
| City | SAN FRANCISCO |
| State | CA |
| Zip Code | 94129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942578521 | Antonia Servat | Marriage & Family Therapist | 6 Funston Ave, San Francisco, CA 94129-1109 | 2011-12-09 |
| 1043788953 | Masonic Homes of California | Psychiatry & Neurology | 6 Funston Ave, San Francisco, CA 94129-1109 | 2018-11-08 |
| 1366849234 | Kiernan Warble | Counselor | 6 Funston Ave, San Francisco, CA 94129-1109 | 2014-11-20 |
| 1083026504 | Shannon Jawahar Dodani | Psychologist | 6 Funston Ave, San Francisco, CA 94129-1109 | 2014-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801362652 | Jamin N Gorham | Physical Therapist | 1162 B Gorgas Avenue, San Francisco, CA 94129 | 2018-10-19 |
| 1942743307 | Kristin Elizabeth Goodrich | Physical Therapist | 1162 B Gorgas Ave, San Francisco, CA 94129 | 2016-12-02 |
| 1356822449 | Matthew Timothy Kuik | Physical Therapist | 1162 B Gorgas Ave, San Francisco, CA 94129 | 2018-08-27 |
| 1285286211 | Derek Wei-yun Wong | Behavior Technician | 1520 Pershing Dr Apt F, San Francisco, CA 94129-1096 | 2019-07-10 |
| 1841403052 | William Meehan | Psychologist | 10 Funston Avenue, The Presidio, San Francisco, CA 94129-1109 | 2007-05-07 |
| 1710017801 | Judith R Levin | Counselor | 10 Funston Ave, The Presidi, San Francisco, CA 94129-1109 | 2007-03-07 |
| 1174021182 | Gouverneur M Carnochan | Psychologist | 10 Funston Ave, San Francisco, CA 94129-1109 | 2018-01-24 |
| 1184095887 | Helga Fasching | Psychologist | 10 Funston Ave, San Francisco, CA 94129-1109 | 2015-10-07 |
| 1134489974 | Barbara Ivy Sharp | Psychologist | 10 Funston Ave, San Francisco, CA 94129-1109 | 2012-05-28 |
| 1457686545 | John Aloysius Sullivan | Psychologist | 10 Funston Ave, San Francisco, CA 94129-1109 | 2009-10-07 |
| Find all providers in zip 94129 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679192116 | Elemental Health | Clinic/Center | 230 Central Ave Apt 11, San Francisco, CA 94117-2052 | 2020-04-14 |
| 1134639388 | Theresa C. Kira, Psyd, A Psychological Corporation | Clinic/Center | 870 Market St Ste 800, San Francisco, CA 94102-2903 | 2017-10-02 |
| 1043578198 | Healthright 360 | Clinic/Center | 555 Franklin St, San Francisco, CA 94102-4456 | 2012-04-26 |
| 1295092815 | Healthright 360 | Clinic/Center | 2290 14th Ave, San Francisco, CA 94116-1841 | 2012-04-20 |
| 1265638159 | University of Califronia, San Francisco | Clinic/Center | 1001 Potrero Ave, Building 5, Suite 6b, San Francisco, CA 94110 | 2007-06-26 |
| 1740486315 | University of California, San Francisco | Clinic/Center | 1001 Potrero Ave # 6b, San Francisco, CA 94110-3518 | 2007-06-21 |
| 1760031314 | The Healthy Teen Project, Inc. | Clinic/Center | 1400 Tennessee St Unit 3, San Francisco, CA 94107-3421 | 2019-09-06 |
| 1104198670 | St Marys Medical Center | Clinic/Center | 450 Stanyan St, San Francisco, CA 94117-1019 | 2012-01-31 |
| 1174729065 | University of California, San Francisco | Clinic/Center | 995 Potrero Ave, Bldg 80, Ward 80, Basement Room 8000 S, San Francisco, CA 94110 | 2007-06-26 |
| 1811072796 | Edgewood Center for Children and Families | Clinic/Center | 1801 Vicente St, San Francisco, CA 94116-2923 | 2006-10-26 |
| Find all providers in SAN FRANCISCO | ||||
| City | SAN FRANCISCO |
| Zip Code | 94129 |
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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.