Provider Demographics
NPI:1598892135
Name:MORDASINI, DONALD JOSEPH
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JOSEPH
Last Name:MORDASINI
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:PO BOX 1843
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:831-479-8604
Mailing Address - Fax:408-559-3158
Practice Address - Street 1:2542 SOUTH BASCOM AVE
Practice Address - Street 2:#207
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-559-3038
Practice Address - Fax:408-559-3158
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32511106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist