Provider Demographics
NPI:1811652621
Name:DIFURIA, JOAN LESLIE (MFT)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:LESLIE
Last Name:DIFURIA
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 1:905 SIR FRANCIS DRAKE BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1589
Mailing Address - Country:US
Mailing Address - Phone:415-457-8774
Mailing Address - Fax:
Practice Address - Street 1:905 SIR FRANCIS DRAKE BLVD STE F
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1589
Practice Address - Country:US
Practice Address - Phone:415-457-8774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health