Provider Demographics
NPI:1134341324
Name:FREDERICO, GLORIA ANNE (MFT)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:ANNE
Last Name:FREDERICO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:ANNE
Other - Last Name:FRUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:213 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-1914
Mailing Address - Country:US
Mailing Address - Phone:650-508-1530
Mailing Address - Fax:650-508-1526
Practice Address - Street 1:1701 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1727
Practice Address - Country:US
Practice Address - Phone:415-452-2200
Practice Address - Fax:415-334-5712
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC34997106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist