Provider Demographics
NPI:1003007238
Name:STEFONETTI, MARILYN (LMFT, NE)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:STEFONETTI
Suffix:
Gender:F
Credentials:LMFT, NE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PETALUMA BLVD N STE B4
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3051
Mailing Address - Country:US
Mailing Address - Phone:707-762-3660
Mailing Address - Fax:
Practice Address - Street 1:6 PETALUMA BLVD N STE B4
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3051
Practice Address - Country:US
Practice Address - Phone:707-762-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist