Healthcare Provider Details

I. General information

NPI: 1487913596
Provider Name (Legal Business Name): JANEEN VIEIRA-TAYLOR MTF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3371 PARKER HILL RD
SANTA ROSA CA
95404-1732
US

IV. Provider business mailing address

1100 LINCOLN AVE
NAPA CA
94558-4900
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-9028
  • Fax: 707-255-3715
Mailing address:
  • Phone: 707-255-3718
  • Fax: 707-255-3715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number65114
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: