Provider Demographics
NPI:1245581164
Name:KILLORAN, MARY PAT (MSW)
Entity Type:Individual
Prefix:
First Name:MARY PAT
Middle Name:
Last Name:KILLORAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARY PATRICIA
Other - Middle Name:
Other - Last Name:KILLORAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:856 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1912
Mailing Address - Country:US
Mailing Address - Phone:650-575-1104
Mailing Address - Fax:
Practice Address - Street 1:856 14TH AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1912
Practice Address - Country:US
Practice Address - Phone:650-395-8045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL007506101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health