Provider Demographics
NPI:1518008812
Name:CINNAMON, DANA MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:CINNAMON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:RIVKAH
Other - Middle Name:
Other - Last Name:CINNAMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:2300 ALESSANDRO DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3747
Mailing Address - Country:US
Mailing Address - Phone:805-216-7560
Mailing Address - Fax:
Practice Address - Street 1:2300 ALESSANDRO DR
Practice Address - Street 2:SUITE 106
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-3747
Practice Address - Country:US
Practice Address - Phone:805-216-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35583106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist