FAMILY SERVICE AGENCY (NPI# 1861561946) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861561946 |
| Entity Type | Organization |
| Organization Name | FAMILY SERVICE AGENCY |
| Practice Address |
555 Northgate Dr San Rafael CA 94903-3680 |
| Practice Telephone | 4154915700 |
| Mailing Telephone | 4154915700 |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2014-07-28 |
| Authorized Official Name | MS. RACHELLE AVERBACH IV (PSYCHOTHERAPIST) |
| Authorized Official Telephone | 4154534662 |
| Authorized Official Credential | MFT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | MFT 23824 | CA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427380385 | Family Service Agency | Counselor | 943 S Gilbert Rd, Ste. 400, Mesa, AZ 85204-4441 | 2010-02-03 |
| 1740487222 | Family Service Agency | Voluntary or Charitable | 1107 S Gilbert Rd, Suite 104, Mesa, AZ 85204-5232 | 2007-06-28 |
| 1255538732 | Family Service Agency | Voluntary or Charitable | 10220 N 31st Ave Ste 103-105, Phoenix, AZ 85051-9581 | 2007-06-28 |
| 1477597193 | Family Service Agency | Voluntary or Charitable | 2400 N. Central Avenue, Suite 101, Phoenix, AZ 85004-1341 | 2006-06-15 |
| 1184974347 | Family Service Agency | Community/Behavioral Health | 104 Walnut Ave, Suite 208, Santa Cruz, CA 95060-3900 | 2012-09-14 |
| 1942587217 | Family Service Agency | Point of Service | 943 S Gilbert Rd, Mesa, AZ 85204-4441 | 2011-11-14 |
| 1013071232 | Family Service Agency | Community/Behavioral Health | 555 Northgate Dr, Family Service Agency of Marin, San Rafael, CA 94903-3680 | 2006-12-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | FAMILY SERVICE AGENCY | 535 Marmion Ave, Youngstown, OH 44502-2323 |
| System for Award Management (SAM) Entities | FAMILY SERVICE AGENCY OF MICHIGAN | 1422 W Court St, Flint, MI 48503-5008 |
| System for Award Management (SAM) Entities | FAMILY SERVICE AGENCY OF SANTA BARBARA COUNTY | 123 W Gutierrez St, Santa Barbara, CA 93101-3424 |
| Washington State Corporations | FAMILY SERVICE AGENCY OF SANTA BARBARA COUNTY | 123 W Gutierrez St, Santa Barbara, CA 93101-3424 |
| Street Address |
555 NORTHGATE DR |
| City | SAN RAFAEL |
| State | CA |
| Zip Code | 94903-3680 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548270267 | Family Service Agency of Marin | Clinic/Center | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2006-08-08 |
| 1851807077 | Jose Luis Tijero Jr. | Counselor | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2017-12-26 |
| 1952845869 | Jessica Copeland | Counselor | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2016-12-12 |
| 1235599036 | Connie Mann | Counselor | 555 Northgate Dr, Suite 200, San Rafael, CA 94903-3680 | 2016-03-07 |
| 1932595683 | Stephanie Schuman | Counselor | 555 Northgate Dr, Suite 200, San Rafael, CA 94903-3680 | 2015-04-09 |
| 1285043620 | Megan Fuller O'donnell | Counselor | 555 Northgate Dr, Suite 100 Family Service Agency of Marin, San Rafael, CA 94903-3680 | 2014-08-11 |
| 1801147103 | Marion Turner-riley | Counselor | 555 Northgate Dr, Family Service Agency of Marin, San Rafael, CA 94903-3680 | 2012-09-26 |
| 1801147616 | Teresa Michelle Vera | Counselor | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2012-09-20 |
| 1629326798 | Stephanie Claire Lai | Counselor | 555 Northgate Dr, Suite 100, San Rafael, CA 94903-3680 | 2012-08-21 |
| 1831460476 | Joanne Forman | Counselor | 555 Northgate Dr, San Rafael, CA 94903-3680 | 2012-01-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467089524 | Christopher Sazo | Counselor | 1 St. Vincents Drive, San Rafael, CA 94903 | 2020-03-26 |
| 1134769482 | Katherine Sieger | Music Therapist | 400 Civic Center Dr. #300, San Rafael, CA 94903 | 2020-01-14 |
| 1679064836 | California In Home Care & Registry, Inc | In Home Supportive Care | 14b Mitchell Blvd, Suite B, San Rafael, CA 94903 | 2018-05-23 |
| 1922557586 | Helen Elizabeth Shamis | Marriage & Family Therapist | 30 North San Pedro, Suite #265, Beyond Hunger, San Rafael, CA 94903 | 2016-09-23 |
| 1033572771 | Henry Colbert | Counselor | 1 St. St. Vincent Drive, San Rafael, CA 94903 | 2016-03-31 |
| 1659736924 | Robyn Bloom | Marriage & Family Therapist | 4 Joseph Court, San Rafael, CA 94903 | 2015-12-30 |
| 1851760565 | Cheryl Clementson | Substance Abuse Rehabilitation Facility | 301 Smith Ranch Road, San Rafael, CA 94903 | 2015-09-23 |
| 1588043731 | Chelsea Cooney | Counselor | 1 St. Vincent's Drive, San Rafael, CA 94903 | 2015-05-20 |
| 1083002315 | Kaiser Permanente | Psychiatric Unit | 111 Smith Ranch Road, Kaiser Permanente, San Rafael, CA 94903 | 2015-01-09 |
| 1366857856 | Travel Well Corporation | Preventive Medicine | 28 Mitchell Blvd, San Rafael, CA 94903 | 2014-06-24 |
| Find all providers in zip 94903 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780207134 | Marianne Haissman Stefancic | Marriage & Family Therapist | 409 Forbes Ave., San Rafael, CA 94901 | 2020-05-20 |
| 1568081586 | Leslie Dempsey | Marriage & Family Therapist | 256 Orris Ter, San Rafael, CA 94903-2510 | 2020-04-09 |
| 1548898653 | Rochelle Edwards | Marriage & Family Therapist | 2173 Francisco Blvd E Ste B, San Rafael, CA 94901-5523 | 2020-04-01 |
| 1699232074 | Pamela Meyer | Marriage & Family Therapist | 1330 Lincoln Ave Ste 208d, San Rafael, CA 94901-2142 | 2019-02-21 |
| 1043774052 | Collin Hoctor | Marriage & Family Therapist | 712 D St Ste P, San Rafael, CA 94901-3706 | 2019-01-23 |
| 1568967768 | Paula F Mierzejewski | Marriage & Family Therapist | 710 C St Ste 9, San Rafael, CA 94901-3853 | 2018-03-28 |
| 1275052516 | Laura Ellen Silverstein | Marriage & Family Therapist | 600 Fifth Avenue, San Rafael, CA 94901 | 2017-09-19 |
| 1114450715 | Jay Stone Rice | Marriage & Family Therapist | 2173 Francisco Blvd E Ste J, San Rafael, CA 94901-5523 | 2017-04-10 |
| 1467997809 | Sara Elizabeth Gardner | Marriage & Family Therapist | 448 Du Bois St, San Rafael, CA 94901-3911 | 2016-12-20 |
| 1740724467 | Lisa Hauck-loy | Marriage & Family Therapist | 1330 Lincoln Ave Ste 306, San Rafael, CA 94901-2143 | 2016-12-14 |
| Find all providers in SAN RAFAEL | ||||
| City | SAN RAFAEL |
| Zip Code | 94903 |
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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.