Provider Demographics
NPI:1457421976
Name:PIASENTIN, REBECCA KAY (REBECCA PIASENTIN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:KAY
Last Name:PIASENTIN
Suffix:
Gender:F
Credentials:REBECCA PIASENTIN
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:KAY
Other - Last Name:PRINCE-PIASENTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:260 MAPLE CT
Mailing Address - Street 2:SUITE 252
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3516
Mailing Address - Country:US
Mailing Address - Phone:805-658-3725
Mailing Address - Fax:805-654-9398
Practice Address - Street 1:260 MAPLE CT
Practice Address - Street 2:SUITE 252
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3516
Practice Address - Country:US
Practice Address - Phone:805-658-3725
Practice Address - Fax:805-654-9398
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health