1992922579 NPI number — MS. CAROL IANTUONO M.F.T.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992922579 NPI number — MS. CAROL IANTUONO M.F.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IANTUONO
Provider First Name:
CAROL
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.F.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992922579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 EAST PROSPECT AVE
Provider Second Line Business Mailing Address:
STE 215 C
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-820-8191
Provider Business Mailing Address Fax Number:
925-820-5369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 EAST PROSPECT AVE
Provider Second Line Business Practice Location Address:
STE 215 C
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94526-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-820-8191
Provider Business Practice Location Address Fax Number:
925-820-5369
Provider Enumeration Date:
04/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 17878 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MFC 17878 . This is a "MARRIAGE & FAMILY THERAPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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