NPIMap

Organization Active NPI

Child Therapy Institute of Marin

  • Community/Behavioral Health Agency
  • Corte Madera, CA
National Provider Identifier
1790216489
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
CHILD THERAPY INSTITUTE OF MARIN
Practice address
240 Tamal Vista Blvd
#155
Corte Madera, CA 94925-1132
Phone
(415) 456-7724
Fax
(415) 456-1050
NPI assigned
Mar 23, 2017
Last updated
Mar 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

240 Tamal Vista Blvd
#155
Corte Madera, CA 94925-1132

Mailing address

1480 Lincoln Ave
#8
San Rafael, CA 94901-2084
Phone (415) 456-7724

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

240 Tamal Vista Blvd
Ste 155
Corte Madera, CA 94925

NPI Registry JSON

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

{
    "created_epoch": "1490227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490227200000",
    "number": "1790216489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1480 LINCOLN AVE",
            "address_2": "#8",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012084",
            "telephone_number": "415-456-7724",
            "fax_number": "415-456-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 TAMAL VISTA BLVD",
            "address_2": "#155",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251132",
            "telephone_number": "415-456-7724",
            "fax_number": "415-456-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD THERAPY INSTITUTE OF MARIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-23",
        "last_updated": "2017-03-23",
        "status": "A",
        "authorized_official_last_name": "LUKAS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "415-456-7724",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Corte Madera, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2017; 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.