Provider Demographics
NPI:1881136786
Name:PENNACHIO, KLARA ELIZA (LMFT)
Entity type:Individual
Prefix:
First Name:KLARA
Middle Name:ELIZA
Last Name:PENNACHIO
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:PO BOX 2546
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93423-2546
Mailing Address - Country:US
Mailing Address - Phone:818-813-3903
Mailing Address - Fax:
Practice Address - Street 1:8850 OLD SANTA ROSA RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-5416
Practice Address - Country:US
Practice Address - Phone:818-813-3903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT113128106H00000X
IMF95894101YM0800X
CAIMF95894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health