Provider Demographics
NPI:1083711782
Name:MASUDA, JANETT MARIE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:JANETT
Middle Name:MARIE
Last Name:MASUDA
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 1:17499 BLUE JAY DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-6428
Mailing Address - Country:US
Mailing Address - Phone:408-859-4864
Mailing Address - Fax:
Practice Address - Street 1:17499 BLUE JAY DR
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-6428
Practice Address - Country:US
Practice Address - Phone:408-859-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist