| On The Margins Family Therapy & Psychological Services, Inc. | |
|
245 Kentucky St Ste E Petaluma CA 94952-2877 | |
| (415) 212-9064 | |
| Not Available |
| Full Name | On The Margins Family Therapy & Psychological Services, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 245 Kentucky St Ste E, Petaluma, California |
| Authorized Official Name and Position | Daniela Dominguez (FOUNDER AND CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4152095592 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| On The Margins Family Therapy & Psychological Services, Inc. 245 Kentucky St Ste E Petaluma CA 94952-2877 Ph: (415) 212-9064 | On The Margins Family Therapy & Psychological Services, Inc. 245 Kentucky St Ste E Petaluma CA 94952-2877 Ph: (415) 212-9064 |
| NPI Number | 1043937790 |
|---|---|
| Provider Enumeration Date | 10/24/2022 |
| Last Update Date | 10/03/2024 |
| Certification Date | 10/03/2024 |
| Medicare PECOS PAC ID | 4486027604 |
|---|---|
| Medicare Enrollment ID | O20230308001899 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043937790 | NPI | - | NPPES |
| Provider Name | Daniela Dominguez |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720705460 PECOS PAC ID: 5395118517 Enrollment ID: I20230308001975 |
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