Provider Demographics
NPI:1831115864
Name:CASANOVA, ROBERT B (MFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:CASANOVA
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S E ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5132
Mailing Address - Country:US
Mailing Address - Phone:707-544-7000
Mailing Address - Fax:707-544-7006
Practice Address - Street 1:319 S E ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5132
Practice Address - Country:US
Practice Address - Phone:707-544-7000
Practice Address - Fax:707-544-7006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist