Provider Demographics
NPI:1245698372
Name:BONFIGLI, HEIDI CRYSTAL (MS, MA LMFT)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:CRYSTAL
Last Name:BONFIGLI
Suffix:
Gender:F
Credentials:MS, MA LMFT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:CRYSTAL
Other - Last Name:LAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:766 W NAPA ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6452
Mailing Address - Country:US
Mailing Address - Phone:415-246-4961
Mailing Address - Fax:
Practice Address - Street 1:766 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6452
Practice Address - Country:US
Practice Address - Phone:415-246-4961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA117296106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program