Provider Demographics
NPI:1649005786
Name:SHAFRAN-MUKAI, BETH (AMFT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:SHAFRAN-MUKAI
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-2355
Mailing Address - Country:US
Mailing Address - Phone:408-888-8763
Mailing Address - Fax:
Practice Address - Street 1:1760 THE ALAMEDA STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1728
Practice Address - Country:US
Practice Address - Phone:490-963-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148837106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist