Provider Demographics
NPI:1083933568
Name:JACOPETTI, KENNETH (MFT)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:JACOPETTI
Suffix:
Gender:M
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:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:BETHEL ISLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94511-0691
Mailing Address - Country:US
Mailing Address - Phone:925-684-2407
Mailing Address - Fax:925-634-9421
Practice Address - Street 1:14301 BYRON HWY
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:CA
Practice Address - Zip Code:94514-2515
Practice Address - Country:US
Practice Address - Phone:925-684-2407
Practice Address - Fax:925-634-9421
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist