Provider Demographics
NPI:1215345350
Name:OLIVO, JOE JR (MA, MFT)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:OLIVO
Suffix:JR
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:OLIVO
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:363 WALLER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3523
Mailing Address - Country:US
Mailing Address - Phone:415-615-2583
Mailing Address - Fax:
Practice Address - Street 1:414 GOUGH ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4464
Practice Address - Country:US
Practice Address - Phone:415-615-2583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist