Provider Demographics
NPI:1669833570
Name:THE PRIVATE PRACTICE OF MARIA GENEY VILLAVICENCIO - LMFT
Entity Type:Organization
Organization Name:THE PRIVATE PRACTICE OF MARIA GENEY VILLAVICENCIO - LMFT
Other - Org Name:MARIA EUGENIA VINCELLO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:EUGENIA
Authorized Official - Last Name:VINCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-353-7430
Mailing Address - Street 1:380 HAMILTON AVE # 511
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94302-2407
Mailing Address - Country:US
Mailing Address - Phone:650-353-7430
Mailing Address - Fax:650-331-3517
Practice Address - Street 1:1218 ELM LAKE CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-3900
Practice Address - Country:US
Practice Address - Phone:650-353-7430
Practice Address - Fax:650-331-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-19
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51316305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service