Provider Demographics
NPI:1407153679
Name:SACASA, CONSTANTINO JOSE (MFTI)
Entity Type:Individual
Prefix:
First Name:CONSTANTINO
Middle Name:JOSE
Last Name:SACASA
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:TINO
Other - Middle Name:JOSE
Other - Last Name:SACACA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFTI
Mailing Address - Street 1:1650 LAS PLUMAS AVE STE K
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-1657
Mailing Address - Country:US
Mailing Address - Phone:408-272-6726
Mailing Address - Fax:408-259-0865
Practice Address - Street 1:1650 LAS PLUMAS AVE STE K
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1657
Practice Address - Country:US
Practice Address - Phone:408-272-6726
Practice Address - Fax:408-259-0865
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-23
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist