Provider Demographics
NPI:1790859650
Name:TRAJANO, LIBERTINE A (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:LIBERTINE
Middle Name:A
Last Name:TRAJANO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MS
Other - First Name:LIBERTY
Other - Middle Name:
Other - Last Name:TRAJANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:2250 FOURTH AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101
Mailing Address - Country:US
Mailing Address - Phone:619-525-9903
Mailing Address - Fax:619-525-9908
Practice Address - Street 1:2250 FOURTH AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101
Practice Address - Country:US
Practice Address - Phone:619-525-9903
Practice Address - Fax:619-525-9908
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist