Basic Information
Provider Information
NPI: 1710042650
EntityType: 2
ReplacementNPI:  
OrganizationName: CATHOLIC CHARITIES CYO
LastName:  
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Mailing Information
Address1: 180 HOWARD ST
Address2: SUITE 100
City: SAN FRANCISCO
State: CA
PostalCode: 941051614
CountryCode: US
TelephoneNumber: 4159721200
FaxNumber:  
Practice Location
Address1: 1 SAINT VINCENTS DR
Address2:  
City: SAN RAFAEL
State: CA
PostalCode: 949031504
CountryCode: US
TelephoneNumber: 4155072000
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/22/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: HENSON
AuthorizedOfficialFirstName: DAWN
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AuthorizedOfficialTitleorPosition: DAY TREATMENT COORDINATOR
AuthorizedOfficialTelephone: 4155074250
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: LMFT
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
322D00000X CAY Residential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children 

No ID Information.


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