Healthcare Provider Details

I. General information

NPI: 1790038560
Provider Name (Legal Business Name): CALIFORNIA PARENTING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3641 STONY POINT RD
SANTA ROSA CA
95407
US

IV. Provider business mailing address

3650 STANDISH AVE
SANTA ROSA CA
95407
US

V. Phone/Fax

Practice location:
  • Phone: 707-585-3700
  • Fax: 707-585-3883
Mailing address:
  • Phone: 707-585-6108
  • Fax: 707-585-2158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY22027
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSC22463
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC45574
License Number StateCA

VIII. Authorized Official

Name: CAROLINA MARIPOSA
Title or Position: CLINIC DIRECTOR
Credential: MFT
Phone: 707-585-6108