Provider Demographics
NPI:1538367867
Name:JARAKIAN, PAULINE SANDRA (MFT)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:SANDRA
Last Name:JARAKIAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 KENT AVE
Mailing Address - Street 2:APARTMENT 20
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2552
Mailing Address - Country:US
Mailing Address - Phone:510-287-9226
Mailing Address - Fax:
Practice Address - Street 1:3150 HILLTOP MALL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1921
Practice Address - Country:US
Practice Address - Phone:510-287-9226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36982106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist