Provider Demographics
NPI:1750508362
Name:ASSUNTO, VICKIE (MFT)
Entity Type:Individual
Prefix:PROF
First Name:VICKIE
Middle Name:
Last Name:ASSUNTO
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 1:300 PLUM STREET
Mailing Address - Street 2:# 100
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:831-477-1309
Mailing Address - Fax:
Practice Address - Street 1:2805 PORTER ST.
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073
Practice Address - Country:US
Practice Address - Phone:831-427-8300
Practice Address - Fax:831-464-1557
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36577106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist