Provider Demographics
NPI:1750939278
Name:MAYER, IVY ELANA (MFT)
Entity type:Individual
Prefix:MS
First Name:IVY
Middle Name:ELANA
Last Name:MAYER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1921
Mailing Address - Country:US
Mailing Address - Phone:415-342-3677
Mailing Address - Fax:
Practice Address - Street 1:1808 WEDEMEYER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94129-5267
Practice Address - Country:US
Practice Address - Phone:415-342-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist