Provider Demographics
NPI:1487758645
Name:MARSHALL RYAN, PATRICIA A (MFT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
Last Name:MARSHALL RYAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 VICENTE STREET
Mailing Address - Street 2:THE EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-2923
Mailing Address - Country:US
Mailing Address - Phone:415-681-3211
Mailing Address - Fax:415-664-7094
Practice Address - Street 1:1801 VICENTE STREET
Practice Address - Street 2:THE EDGEWOOD CENTER FOR CHILDREN AND FAMILIES
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-2923
Practice Address - Country:US
Practice Address - Phone:415-681-3211
Practice Address - Fax:415-664-7094
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist