Provider Demographics
NPI:1740638055
Name:PICONE, REBECCA M (LMFT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:PICONE
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 1:841 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2704
Mailing Address - Country:US
Mailing Address - Phone:408-225-7932
Mailing Address - Fax:
Practice Address - Street 1:841 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2704
Practice Address - Country:US
Practice Address - Phone:408-225-7932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT18006106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist