Provider Demographics
NPI:1801124367
Name:CONSTANTINO, JANET
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JANET
Other - Middle Name:CONSTANTINO
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:793 1ST ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-7036
Mailing Address - Country:US
Mailing Address - Phone:707-266-0196
Mailing Address - Fax:
Practice Address - Street 1:793 1ST ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-7036
Practice Address - Country:US
Practice Address - Phone:707-266-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-21
Last Update Date:2009-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist