Healthcare Provider Details

I. General information

NPI: 1619030608
Provider Name (Legal Business Name): MARY MAHOOD M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 WHIPPLE ROAD
UNION CITY CA
94587-1507
US

IV. Provider business mailing address

3553 WHIPPLE ROAD
UNION CITY CA
94587-1507
US

V. Phone/Fax

Practice location:
  • Phone: 510-454-1000
  • Fax: 510-675-4315
Mailing address:
  • Phone: 510-454-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMFC29631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: