Provider Demographics
NPI:1477666220
Name:MINEAU, DAVID L
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MINEAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 NOEL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3358
Mailing Address - Country:US
Mailing Address - Phone:650-321-2588
Mailing Address - Fax:
Practice Address - Street 1:1040 NOEL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3358
Practice Address - Country:US
Practice Address - Phone:650-321-2588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 20949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist