Provider Demographics
NPI:1629279757
Name:BACIGALUPI, MARILYN MELLOTT (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:MELLOTT
Last Name:BACIGALUPI
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 1:317 CHAPIN LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5103
Mailing Address - Country:US
Mailing Address - Phone:650-296-1530
Mailing Address - Fax:650-347-7180
Practice Address - Street 1:205 E 3RD AVE
Practice Address - Street 2:315
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4051
Practice Address - Country:US
Practice Address - Phone:650-296-1530
Practice Address - Fax:650-347-7180
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist