Provider Demographics
NPI:1881140960
Name:MAHOOD, PENELOPE MAVRIDIS (MA, MFTI)
Entity type:Individual
Prefix:
First Name:PENELOPE
Middle Name:MAVRIDIS
Last Name:MAHOOD
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 LOS GATOS SARATOGA RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-5310
Mailing Address - Country:US
Mailing Address - Phone:408-458-6384
Mailing Address - Fax:
Practice Address - Street 1:305 LOS GATOS SARATOGA RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5310
Practice Address - Country:US
Practice Address - Phone:408-458-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist