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55 W 5th Ave Apt 9a San Mateo CA 94402-2052 | |
| (650) 458-7737 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 55 W 5th Ave Apt 9a, San Mateo, California |
| Authorized Official Name and Position | Anna Izzo (CEO) |
| Authorized Official Contact | 6504587737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
307 South B Street California CA 94401-4053 Ph: (650) 223-5605 | 55 W 5th Ave Apt 9a San Mateo CA 94402-2052 Ph: (650) 458-7737 |
| NPI Number | 1518557552 |
|---|---|
| Provider Enumeration Date | 01/23/2021 |
| Last Update Date | 08/16/2024 |
| Certification Date | 08/16/2024 |
| Medicare PECOS PAC ID | 5092249490 |
|---|---|
| Medicare Enrollment ID | O20241107002046 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518557552 | NPI | - | NPPES |
| NPI | Other | 1629561816 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Anna Izzo |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1629561816 PECOS PAC ID: 6901330307 Enrollment ID: I20241107002233 |
| Provider Name | Yael Gonicman |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1144759556 PECOS PAC ID: 4183158082 Enrollment ID: I20241114003683 |
| Provider Name | Dalton Wayne Huckaby |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1073263349 PECOS PAC ID: 5698209401 Enrollment ID: I20241114004403 |
| Provider Name | Marylou Torrez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1639836315 PECOS PAC ID: 3971037656 Enrollment ID: I20241118001997 |
| Provider Name | Claire Posel |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1184280877 PECOS PAC ID: 1557895232 Enrollment ID: I20241118002239 |
| Provider Name | Jennifer Fan |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1841366804 PECOS PAC ID: 5698200251 Enrollment ID: I20241120001000 |
| Provider Name | Laura Purpura |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1982377537 PECOS PAC ID: 7517492028 Enrollment ID: I20241120004210 |
| Provider Name | Sara Kenney |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1316402456 PECOS PAC ID: 8729513080 Enrollment ID: I20241122001730 |
| Provider Name | Tara Ann Cronin |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1225107881 PECOS PAC ID: 7012442379 Enrollment ID: I20241122002078 |
| Provider Name | Suzanne Marie Dito |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1851984132 PECOS PAC ID: 8325574114 Enrollment ID: I20241203003380 |
Brightline Medical Associates, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 400 Concar Dr, San Mateo, CA 94402 Phone: 888-224-7332 | |
Transcend Psychotherapy Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1117 S B St Ste 4, San Mateo, CA 94401 Phone: 510-541-4837 Fax: 650-431-2157 | |
Stepping Stones Center For Autistic Spectrum Disorders, Inc, Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3190 Clearview Way, Suite 103, San Mateo, CA 94402 Phone: 650-357-0571 Fax: 650-357-0676 | |
Cep America - Neurology Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 222 W 39th Ave, San Mateo, CA 94403 Phone: 650-573-3982 | |
Richard F. Gravina, M.d. A Medical Corporation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 N. San Mateo Drive, San Mateo, CA 94401 Phone: 650-348-6811 Fax: 650-348-3651 |