Provider Demographics
NPI:1669069290
Name:DELVENTHAL, JULIETTE LEONORE (MA)
Entity type:Individual
Prefix:MS
First Name:JULIETTE
Middle Name:LEONORE
Last Name:DELVENTHAL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:BOLINAS
Mailing Address - State:CA
Mailing Address - Zip Code:94924-0204
Mailing Address - Country:US
Mailing Address - Phone:415-323-8252
Mailing Address - Fax:
Practice Address - Street 1:3702 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1740
Practice Address - Country:US
Practice Address - Phone:415-323-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist