Provider Demographics
NPI:1447383476
Name:CRAVALHO, MARY M (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:CRAVALHO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:NEJAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:39 N SAN MATEO DR STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2832
Mailing Address - Country:US
Mailing Address - Phone:650-266-9250
Mailing Address - Fax:650-685-1864
Practice Address - Street 1:39 N SAN MATEO DR STE 5
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2832
Practice Address - Country:US
Practice Address - Phone:650-266-9250
Practice Address - Fax:650-685-1864
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80568Medicare UPIN
CA363534Medicare UPIN