MEDICARE: PRISCILLA CHENG MA, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	93574	CA

General Provider Information

NPI Number	:	1558614305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA CHENG MA, LMFT

Provider Business Mailing Address
First Line	:	122 2ND AVENUE
Second Line	:	SUITE 212
City	:	SAN MATEO
State	:	CA
Zip	:	94401
Country	:	US
Telephone Number	:	650-701-3978
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 2ND AVE STE 212
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-3836
Country	:	US
Telephone Number	:	650-701-3978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	01/20/2021

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