Provider Demographics
NPI:1164762241
Name:CANCINO, EMMYLOU CHUA (IMF)
Entity Type:Individual
Prefix:MISS
First Name:EMMYLOU
Middle Name:CHUA
Last Name:CANCINO
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:EMMYLOU
Other - Middle Name:
Other - Last Name:CHUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3815 MARCONI AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-3867
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3815 MARCONI AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-3867
Practice Address - Country:US
Practice Address - Phone:707-639-7498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72930106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist