Healthcare Provider Details

I. General information

NPI: 1568072908
Provider Name (Legal Business Name): EMMA MEFOM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 01/03/2022
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 HOMESTEAD RD
SANTA CLARA CA
95051-4542
US

IV. Provider business mailing address

300 PASTEUR DR RM HC 029
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-4938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number94605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: