Provider Demographics
NPI:1497376636
Name:GONSALVES, JULIEANNA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JULIEANNA
Middle Name:
Last Name:GONSALVES
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 BROADWAY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-2401
Mailing Address - Country:US
Mailing Address - Phone:408-772-6363
Mailing Address - Fax:
Practice Address - Street 1:55 SERENO CT
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7285
Practice Address - Country:US
Practice Address - Phone:408-772-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist