Provider Demographics
NPI:1538352893
Name:ENGRACIA, GINA (LMFT)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ENGRACIA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:582 MARKET ST STE 2004
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-5321
Mailing Address - Country:US
Mailing Address - Phone:415-508-7405
Mailing Address - Fax:
Practice Address - Street 1:582 MARKET ST STE 2004
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-5321
Practice Address - Country:US
Practice Address - Phone:415-508-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPMF500106H00000X
NY002165106H00000X
CA53210106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist