Basic Information
| Provider Information | |||||||||
| NPI: | 1689929598 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAFE & SOUND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1757 WALLER ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941172727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153873684 | ||||||||
| FaxNumber: | 4153860959 | ||||||||
| Practice Location | |||||||||
| Address1: | 1757 WALLER ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941172727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153873684 | ||||||||
| FaxNumber: | 4153860959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2012 | ||||||||
| LastUpdateDate: | 11/14/2017 | ||||||||
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| AuthorizedOfficialLastName: | GAINES | ||||||||
| AuthorizedOfficialFirstName: | MALCOLM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4153873684 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY. D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.