Provider Demographics
NPI:1235332966
Name:BURNETT, MITZE ANGELICA (BSW, MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MITZE
Middle Name:ANGELICA
Last Name:BURNETT
Suffix:
Gender:F
Credentials:BSW, MA, LMFT
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ANGELICA
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSW, MA, LMFT
Mailing Address - Street 1:1734 JEFFERSON ST STE B
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1746
Mailing Address - Country:US
Mailing Address - Phone:707-227-4448
Mailing Address - Fax:707-635-8215
Practice Address - Street 1:1734 JEFFERSON ST STE B
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1746
Practice Address - Country:US
Practice Address - Phone:707-227-4448
Practice Address - Fax:707-635-8215
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 50552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIMF 50552OtherMFTI REGISTRATION
CAMFC 50064OtherBOARD OF BEHAVIORAL SCIENCES