Provider Demographics
NPI:1467072348
Name:OLIVERIO, VICKI (MFT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:OLIVERIO
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 1:220C OAK MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4407
Mailing Address - Country:US
Mailing Address - Phone:650-771-2707
Mailing Address - Fax:
Practice Address - Street 1:220C OAK MEADOW DR
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4407
Practice Address - Country:US
Practice Address - Phone:650-771-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC28149OtherLMFT LICENSE, STATE OF CA