Provider Demographics
NPI:1508916149
Name:LI, WAYNE W (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:W
Last Name:LI
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 GEARY BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3109
Mailing Address - Country:US
Mailing Address - Phone:415-833-2292
Mailing Address - Fax:415-833-4765
Practice Address - Street 1:4141 GEARY BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3109
Practice Address - Country:US
Practice Address - Phone:415-833-2292
Practice Address - Fax:415-833-4765
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist