Provider Demographics
NPI:1295994119
Name:CISCO, PATRICIA ANN (MFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:CISCO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 3RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4515
Mailing Address - Country:US
Mailing Address - Phone:707-526-1944
Mailing Address - Fax:707-544-1201
Practice Address - Street 1:865 3RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4515
Practice Address - Country:US
Practice Address - Phone:707-526-1944
Practice Address - Fax:707-544-1201
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist