Healthcare Provider Details

I. General information

NPI: 1407907736
Provider Name (Legal Business Name): GERTRUDE ANNE BONINCONTRO MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 HOMESTEAD RD
CUPERTINO CA
95014-0712
US

IV. Provider business mailing address

212 W IRONWOOD DR STE D
COEUR D ALENE ID
83814-1403
US

V. Phone/Fax

Practice location:
  • Phone: 408-828-3937
  • Fax:
Mailing address:
  • Phone: 408-828-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53792
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number16305
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number70005714
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4635-R
License Number StateNV
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFT 53792
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3271369
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: