Healthcare Provider Details

I. General information

NPI: 1114456241
Provider Name (Legal Business Name): JENNIFER CAPPELLETTI LMFT 146548
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 TAMAL VISTA BLVD
CORTE MADERA CA
94925-1130
US

IV. Provider business mailing address

PO BOX 29
BURLINGAME CA
94011-0029
US

V. Phone/Fax

Practice location:
  • Phone: 415-496-6584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146548
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: