Provider Demographics
NPI:1083478069
Name:BUTTAFUOCO, JESSICA (AMFT # 143957)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BUTTAFUOCO
Suffix:
Gender:F
Credentials:AMFT # 143957
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 TOWNSGATE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5754
Mailing Address - Country:US
Mailing Address - Phone:818-515-2916
Mailing Address - Fax:
Practice Address - Street 1:2625 TOWNSGATE RD STE 210
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-5754
Practice Address - Country:US
Practice Address - Phone:805-497-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO143957106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist