Provider Demographics
NPI:1114251626
Name:FANELLI, DENISE C (MA, ATR, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:C
Last Name:FANELLI
Suffix:
Gender:F
Credentials:MA, ATR, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 OLD RANCH PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740
Mailing Address - Country:US
Mailing Address - Phone:714-394-7266
Mailing Address - Fax:562-596-6024
Practice Address - Street 1:3020 OLD RANCH PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740
Practice Address - Country:US
Practice Address - Phone:714-394-7266
Practice Address - Fax:562-596-6024
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMY23409106H00000X
CAMFC23409106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist