Provider Demographics
NPI:1770848947
Name:BALDASSARI, MATIANNA (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MATIANNA
Middle Name:
Last Name:BALDASSARI
Suffix:
Gender:F
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 1:1129 MARICOPA HWY # 185A
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3126
Mailing Address - Country:US
Mailing Address - Phone:805-633-0006
Mailing Address - Fax:
Practice Address - Street 1:206 GRIDLEY RD
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-9624
Practice Address - Country:US
Practice Address - Phone:805-633-0006
Practice Address - Fax:805-633-0007
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93379106H00000X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner