Provider Demographics
NPI:1629383625
Name:VULFOVICH, NADIA (MFTI)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:VULFOVICH
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W SAN FERNANDO ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-4815
Mailing Address - Country:US
Mailing Address - Phone:718-737-1498
Mailing Address - Fax:
Practice Address - Street 1:815 W SAN FERNANDO ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-4815
Practice Address - Country:US
Practice Address - Phone:718-737-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT100394101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty