Provider Demographics
NPI:1750390019
Name:PFAFF, LORETTA MARY (MFT)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:MARY
Last Name:PFAFF
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 1:2516 SAMARITAN DR
Mailing Address - Street 2:STE D
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4108
Mailing Address - Country:US
Mailing Address - Phone:408-303-2435
Mailing Address - Fax:408-269-2784
Practice Address - Street 1:2516 SAMARITAN DR
Practice Address - Street 2:STE D
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4108
Practice Address - Country:US
Practice Address - Phone:408-303-2435
Practice Address - Fax:408-269-2784
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist