Provider Demographics
NPI:1194182691
Name:PIVER, STANLEY
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:PIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:
Other - Last Name:PIVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:1777 BOREL PL STE 403
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3513
Mailing Address - Country:US
Mailing Address - Phone:510-828-6341
Mailing Address - Fax:510-481-5958
Practice Address - Street 1:1777 BOREL PL STE 403
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-3513
Practice Address - Country:US
Practice Address - Phone:510-828-6341
Practice Address - Fax:510-481-5958
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist