Provider Demographics
NPI:1700115862
Name:FESPERMAN, RENEE (MFT)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:FESPERMAN
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 1:3490 BUSKIRK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4316
Mailing Address - Country:US
Mailing Address - Phone:925-658-5746
Mailing Address - Fax:925-944-5544
Practice Address - Street 1:3490 BUSKIRK AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-658-5746
Practice Address - Fax:925-944-5544
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-18
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist