Provider Demographics
NPI:1073691770
Name:FISHER-CERVONE, JEANNE M (MFT)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:FISHER-CERVONE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2757 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-5943
Mailing Address - Country:US
Mailing Address - Phone:707-255-0897
Mailing Address - Fax:
Practice Address - Street 1:2180 JEFFERSON ST.
Practice Address - Street 2:SUITE 214
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-265-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 19423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health