Provider Demographics
NPI:1780625160
Name:DALEO, JEANNINE MARDI (MFT)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:MARDI
Last Name:DALEO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JEANNINE
Other - Middle Name:MARDI
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3554 ROUND BARN BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0929
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:4700 SPRING ST
Practice Address - Street 2:STE 220
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0263
Practice Address - Country:US
Practice Address - Phone:619-667-3380
Practice Address - Fax:619-667-0815
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38634106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist