Provider Demographics
NPI:1205403623
Name:NGO, PRISCILLA (MA, AMFT, ATR-P)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:NGO
Suffix:
Gender:X
Credentials:MA, AMFT, ATR-P
Other - Prefix:
Other - First Name:NOX
Other - Middle Name:
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:750 ALMA LN UNIT 8062
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-3284
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:260 EDMONDS RD
Practice Address - Street 2:BUILDING C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-374-2299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT144803106H00000X
101YM0800X, 171M00000X
CA24-203221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist