Provider Demographics
NPI:1912116252
Name:COUNTY OF MARIN
Entity type:Organization
Organization Name:COUNTY OF MARIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE PRIVACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:CHPC
Authorized Official - Phone:415-499-3888
Mailing Address - Street 1:10 N SAN PEDRO RD STE 1022
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4155
Mailing Address - Country:US
Mailing Address - Phone:415-473-6948
Mailing Address - Fax:
Practice Address - Street 1:3270 KERNER BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-3030
Practice Address - Fax:415-473-7008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MARIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-22
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health