Provider Demographics
NPI:1568700680
Name:EVERS, MARI KUGOH (LCSW, QMRP)
Entity Type:Individual
Prefix:MS
First Name:MARI
Middle Name:KUGOH
Last Name:EVERS
Suffix:
Gender:F
Credentials:LCSW, QMRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAVIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002
Mailing Address - Country:US
Mailing Address - Phone:650-216-8868
Mailing Address - Fax:
Practice Address - Street 1:31 TOWER ROAD
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402
Practice Address - Country:US
Practice Address - Phone:650-312-5320
Practice Address - Fax:650-572-2414
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW291111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical