Provider Demographics
NPI:1679764468
Name:FRECCERI, JONATHAN NOEL (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:NOEL
Last Name:FRECCERI
Suffix:
Gender:M
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 1:660 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2125
Mailing Address - Country:US
Mailing Address - Phone:408-642-8542
Mailing Address - Fax:650-319-4212
Practice Address - Street 1:660 MIDDLEFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2125
Practice Address - Country:US
Practice Address - Phone:408-642-8542
Practice Address - Fax:650-319-4212
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist