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General NPI Number Information
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NPI Number | 1851029706
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Entity Type | Individual
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Provider Name | CORY CRAVALHO
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Gender | Male
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Dates
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Enumeration Date | 08/09/2022
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 12 W SANTA INEZ AVE
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City | SAN MATEO
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State | CA
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Zip | 94402-1222
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Country | US
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Telephone | 650-218-2704
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 LAUREL ST # CA
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City | SAN CARLOS
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State | CA
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Zip | 94070-3918
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Country | US
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Telephone | 650-394-5155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 154950
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License Number State | CA
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