Provider Demographics
NPI:1962561704
Name:MARSH, JENNIFER MARGARET (MFT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:MARGARET
Last Name:MARSH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:MARSH
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2 COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-6123
Mailing Address - Country:US
Mailing Address - Phone:415-883-9222
Mailing Address - Fax:415-883-3014
Practice Address - Street 1:2 COMMERCIAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6123
Practice Address - Country:US
Practice Address - Phone:415-883-9222
Practice Address - Fax:415-883-3014
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist