Provider Demographics
NPI:1295254852
Name:MATO VILAR, PENELOPE (MFTI)
Entity type:Individual
Prefix:MISS
First Name:PENELOPE
Middle Name:
Last Name:MATO VILAR
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 1:126 LAGUNA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5716
Mailing Address - Country:US
Mailing Address - Phone:415-240-7326
Mailing Address - Fax:
Practice Address - Street 1:638 WEBSTER ST STE 400
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4168
Practice Address - Country:US
Practice Address - Phone:415-240-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist