Provider Demographics
NPI:1467525485
Name:GAETANO, BARBARA A (MFT)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:A
Last Name:GAETANO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 OBERLIN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1786
Mailing Address - Country:US
Mailing Address - Phone:858-453-9539
Mailing Address - Fax:
Practice Address - Street 1:5755 OBERLIN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1786
Practice Address - Country:US
Practice Address - Phone:858-453-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC29969OtherMARRIAGE & FAMILY THERAPI