Provider Demographics
NPI:1730662818
Name:THE CHILD THERAPY INSTITUTE OF MARIN
Entity type:Organization
Organization Name:THE CHILD THERAPY INSTITUTE OF MARIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUGHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-456-7724
Mailing Address - Street 1:1480 LINCOLN AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13925 SAN PABLO AVE STE 201&203&205
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3652
Practice Address - Country:US
Practice Address - Phone:415-456-7724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)