Provider Demographics
NPI:1215353842
Name:WONG-AGEE, CAMEO
Entity type:Individual
Prefix:
First Name:CAMEO
Middle Name:
Last Name:WONG-AGEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 EVANS AVE
Mailing Address - Street 2:SUITE A/B
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124
Mailing Address - Country:US
Mailing Address - Phone:415-206-7674
Mailing Address - Fax:
Practice Address - Street 1:1309 EVANS AVE
Practice Address - Street 2:SUITE A/B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124
Practice Address - Country:US
Practice Address - Phone:415-206-7674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC 3517101YM0800X
CALMFT 95953106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health