Provider Demographics
NPI:1255983060
Name:O'DONNELL, ENNA RUTH OPREANU (LMFT)
Entity type:Individual
Prefix:
First Name:ENNA RUTH
Middle Name:OPREANU
Last Name:O'DONNELL
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 1:639 MOANA WAY
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2841
Mailing Address - Country:US
Mailing Address - Phone:415-577-3639
Mailing Address - Fax:
Practice Address - Street 1:639 MOANA WAY
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2841
Practice Address - Country:US
Practice Address - Phone:415-577-3639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119842106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist