Provider Demographics
NPI:1306535273
Name:MASTANDREA, VANESSA (LMFT)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MASTANDREA
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 1:14393 PARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-3302
Mailing Address - Country:US
Mailing Address - Phone:442-327-9135
Mailing Address - Fax:
Practice Address - Street 1:14393 PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-3302
Practice Address - Country:US
Practice Address - Phone:442-327-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142132106H00000X, 106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator