Healthcare Provider Details

I. General information

NPI: 1518557552
Provider Name (Legal Business Name): IZZO MARRIAGE & FAMILY THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S B ST STE 4
SAN MATEO CA
94401-4054
US

IV. Provider business mailing address

307 SOUTH B STREET
CALIFORNIA CA
94401-4053
US

V. Phone/Fax

Practice location:
  • Phone: 650-223-5605
  • Fax:
Mailing address:
  • Phone: 650-223-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANNA IZZO
Title or Position: CEO
Credential: LMFT
Phone: 650-458-7737