=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447383476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY M. CRAVALHO M.A., LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 N SAN MATEO DR STE 5
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94401-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-266-9250
-----------------------------------------------------
Fax | 650-685-1864
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 N SAN MATEO DR STE 5
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94401-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-266-9250
-----------------------------------------------------
Fax | 650-685-1864
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC40063
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------