Provider Demographics
NPI:1053504720
Name:PINNELLI, DANA MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:MARIE
Last Name:PINNELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4696
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-0696
Mailing Address - Country:US
Mailing Address - Phone:209-406-7095
Mailing Address - Fax:
Practice Address - Street 1:19 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-4107
Practice Address - Country:US
Practice Address - Phone:209-835-8583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF54353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist