Active NPI
Ivy Wang
- Marriage & Family Therapist
- San Mateo, CA
National Provider Identifier
1184101909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- AMFT134804
- Practice address
- 307 S B St
San Mateo, CA 94401-4053 - Phone
- (415) 999-5923
- NPI assigned
- Jul 24, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Community Health Worker | 172V00000X | |||
| Marriage & Family Therapist | 106H00000X | AMFT134804 | CA | Primary |
Addresses
Primary practice location
307 S B St
San Mateo, CA 94401-4053
Mailing address
307 S B St
San Mateo, CA 94401-4053
Other practice location 1
1038 Post St
San Francisco, CA 94109-5603
Phone (415) 775-2636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMFT134804 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682467200000",
"number": "1184101909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "307 S B ST",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944014053"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "307 S B ST",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944014053",
"telephone_number": "415-999-5923"
}
],
"practiceLocations": [
{
"address_1": "1038 Post St",
"address_purpose": "LOCATION",
"city": "San Francisco",
"state": "CA",
"postal_code": "941095603",
"country_code": "US",
"telephone_number": "415-775-2636",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WANG",
"first_name": "IVY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-24",
"last_updated": "2023-04-26",
"certification_date": "2023-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "AMFT134804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.