NPIMap

Organization Active NPI

Child Therapy Institute of Marin

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Petaluma, CA
National Provider Identifier
1154713774
Registry record updated Feb 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CHILD THERAPY INSTITUTE OF MARIN
Practice address
720 Southpoint Blvd
Petaluma, CA 94954-7495
Phone
(707) 237-3644
NPI assigned
Feb 19, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brian N Lukas, PHD
Title
Executive Director
Phone
(415) 456-7724

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

720 Southpoint Blvd
Petaluma, CA 94954-7495

Mailing address

1480 Lincoln Ave Ste 8
San Rafael, CA 94901-2085

National Provider Directory

National Provider Directory
Tax ID family
Child Therapy Institute21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

720 Southpoint Blvd
Petaluma, CA 94954
Phone (707) 237-3644

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424304000000",
    "number": "1154713774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 LINCOLN AVE STE 8",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 SOUTHPOINT BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949547495",
            "telephone_number": "707-237-3644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD THERAPY INSTITUTE OF MARIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-19",
        "last_updated": "2015-02-19",
        "status": "A",
        "authorized_official_last_name": "LUKAS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "415-456-7724",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.