Provider Demographics
NPI:1073894317
Name:DISANTO, JANET CROCE (MFT)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:CROCE
Last Name:DISANTO
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 1:10 RENZ RD
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1726
Mailing Address - Country:US
Mailing Address - Phone:415-383-4385
Mailing Address - Fax:415-383-4385
Practice Address - Street 1:10 RENZ RD
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1726
Practice Address - Country:US
Practice Address - Phone:415-383-4385
Practice Address - Fax:415-383-4385
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT13221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist