Healthcare Provider Details

I. General information

NPI: 1629383625
Provider Name (Legal Business Name): NADIA VULFOVICH MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 W SAN FERNANDO ST
SAN JOSE CA
95126-4815
US

IV. Provider business mailing address

815 W SAN FERNANDO ST
SAN JOSE CA
95126-4815
US

V. Phone/Fax

Practice location:
  • Phone: 718-737-1498
  • Fax:
Mailing address:
  • Phone: 718-737-1498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT100394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: