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General NPI Number Information
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NPI Number | 1285861534
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Entity Type | Individual
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Provider Name | JEANNETTE LONGTIN LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/14/2009
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 905 SIR FRANCIS DRAKE BLVD SUITE F
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City | KENTFIELD
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State | CA
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Zip | 94904-1588
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Country | US
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Telephone | 415-785-7142
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Fax | 745-485-1571
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Provider Business Mailing Address
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Address Line | 27 BLOSSOM DR
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City | SAN RAFAEL
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State | CA
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Zip | 94901-5213
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Country | US
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Telephone | 415-785-7142
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Fax | 415-485-1571
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC20579
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License Number State | CA
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