Basic Information
Provider Information
NPI: 1477690063
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ST. JOHN
FirstName: MARIA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2550 23RD ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941103504
CountryCode: US
TelephoneNumber: 4152065270
FaxNumber: 4152064722
Practice Location
Address1: 1001 POTRERO AVE
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941103518
CountryCode: US
TelephoneNumber: 4152063752
FaxNumber: 4152064722
Other Information
ProviderEnumerationDate: 01/31/2007
LastUpdateDate: 08/21/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000XMFC 32820CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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