Provider Demographics
NPI:1568838985
Name:AWAKE DBT MARRIAGE AND FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:AWAKE DBT MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:SANGUINETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:408-375-6301
Mailing Address - Street 1:913 WILLOW ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-2380
Mailing Address - Country:US
Mailing Address - Phone:408-375-6301
Mailing Address - Fax:408-693-3738
Practice Address - Street 1:913 WILLOW ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-2380
Practice Address - Country:US
Practice Address - Phone:408-375-6301
Practice Address - Fax:408-693-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43603106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty