Provider Demographics
NPI:1962803825
Name:MARIN, SHIRA (PHD, LMFT)
Entity type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 DEVON DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3709
Mailing Address - Country:US
Mailing Address - Phone:415-499-0737
Mailing Address - Fax:415-499-8242
Practice Address - Street 1:391 DEVON DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3709
Practice Address - Country:US
Practice Address - Phone:415-499-0737
Practice Address - Fax:415-499-8242
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15972106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist