Provider Demographics
NPI:1033258132
Name:ENDRES, ABBIGAIL J (MFT)
Entity Type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:J
Last Name:ENDRES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-2303
Mailing Address - Country:US
Mailing Address - Phone:415-861-3205
Mailing Address - Fax:
Practice Address - Street 1:1720 S AMPHLETT BLVD
Practice Address - Street 2:SUITE #123
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2702
Practice Address - Country:US
Practice Address - Phone:650-655-4035
Practice Address - Fax:650-578-8697
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC43308OtherMFT