Provider Demographics
NPI:1336668318
Name:MENSOFF, SWEET ALYSSUM (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SWEET
Middle Name:ALYSSUM
Last Name:MENSOFF
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:ALYSSUM
Other - Middle Name:
Other - Last Name:MENSOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:708 GRAVENSTEIN HWY N # 355
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2808
Mailing Address - Country:US
Mailing Address - Phone:707-347-9749
Mailing Address - Fax:
Practice Address - Street 1:205 KELLER ST STE 205
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2878
Practice Address - Country:US
Practice Address - Phone:707-347-9749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101790OtherBOARD OF BEHAVIORAL SCIENCES