Healthcare Provider Details

I. General information

NPI: 1801919642
Provider Name (Legal Business Name): JEANNE VATTUONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 3RD ST SUITE 204
SANTA ROSA CA
95404-4515
US

IV. Provider business mailing address

865 3RD ST SUITE 204
SANTA ROSA CA
95404-4515
US

V. Phone/Fax

Practice location:
  • Phone: 707-322-3843
  • Fax:
Mailing address:
  • Phone: 707-322-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18987
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: