Provider Demographics
NPI:1801337456
Name:CAVIGIOLI, WAN-PING (MA)
Entity type:Individual
Prefix:MRS
First Name:WAN-PING
Middle Name:
Last Name:CAVIGIOLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:CAVIGIOLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1510 FASHION ISLAND BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94404-5043
Mailing Address - Country:US
Mailing Address - Phone:650-570-7273
Mailing Address - Fax:
Practice Address - Street 1:1510 FASHION ISLAND BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-5043
Practice Address - Country:US
Practice Address - Phone:650-570-7273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 98667106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist