Provider Demographics
NPI:1881866705
Name:CERVANTES, CATHERINE C (LMFT)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:C
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MISSION ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3661
Mailing Address - Country:US
Mailing Address - Phone:831-227-3412
Mailing Address - Fax:
Practice Address - Street 1:501 MISSION ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3661
Practice Address - Country:US
Practice Address - Phone:831-227-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52978106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ91892ZOtherSANTA CRUZ COUNTY MEDICARE GROUP PTAN#