Provider Demographics
NPI:1437501939
Name:DELMONTE, ANNE (MFCC LIC # 25427)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:DELMONTE
Suffix:
Gender:F
Credentials:MFCC LIC # 25427
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:TAYLOR
Other - Last Name:DEL MONTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFCC LIC # 25427
Mailing Address - Street 1:24 URSULINE RD
Mailing Address - Street 2:A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1729
Mailing Address - Country:US
Mailing Address - Phone:707-526-1167
Mailing Address - Fax:707-527-6417
Practice Address - Street 1:24 URSULINE RD
Practice Address - Street 2:A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1729
Practice Address - Country:US
Practice Address - Phone:707-526-1167
Practice Address - Fax:707-527-6417
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25427OtherMFCC LICENSE NUMBER
11700935OtherCAQH PROVIDER ID