Provider Demographics
NPI:1710291166
Name:ROMANIELLO, JO (MFT)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:
Last Name:ROMANIELLO
Suffix:
Gender:F
Credentials:MFT
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 1409
Mailing Address - Street 2:
Mailing Address - City:BOULDER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95006-1409
Mailing Address - Country:US
Mailing Address - Phone:831-246-1512
Mailing Address - Fax:
Practice Address - Street 1:6630 HIGHWAY 9
Practice Address - Street 2:SUITE 205
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9711
Practice Address - Country:US
Practice Address - Phone:831-246-1512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist