Paul Martin Agustinovich, PH.D.
Individual provider Active NPI Marriage & Family Therapist · San Mateo, CA
NPI 1508958976 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508958976
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- MFC32652 (CA)
- Practice address
- 501 1St Ave
Ste. 1a
San Mateo, CA 94401-3213 - Phone
- (650) 348-0755
- Fax
- (650) 685-6618
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 28, 2025 through Feb 28, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32652 | CA | MD | Clinical Psychologist |
| MFC32652 | CA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC32652 | CA | Yes |
Addresses
Primary practice location
501 1St Ave
Ste. 1a
San Mateo, CA 94401-3213
Mailing address
501 1St Ave
Ste. 1a
San Mateo, CA 94401-3213
Phone (650) 348-0755
Other providers in San Mateo, CA
- Michelle Aguilar
- Larry Alexander Aguilera
- Bianca Yamilette Aguiniga Pantoja
- Guadalupe Aguirre Perez
- Patricia Isabel Aguirre
- Arsalan Ahani
- Mitra Ahani
- Erum Ahmed
- Zan Ahsan
- Zara Aijaz
All providers in San Mateo, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.