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General NPI Number Information
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NPI Number | 1306548045
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Entity Type | Organization
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Legal Business Name | RECONNECT THERAPY
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 4127 SANTA ROSA AVE
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City | SACRAMENTO
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State | CA
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Zip | 95817-3442
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Country | US
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Telephone | 916-513-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 5716 FOLSOM BLVD # 348
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City | SACRAMENTO
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State | CA
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Zip | 95819-4608
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Country | US
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Telephone | 916-513-0466
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Fax |
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Authorized Official
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Title or Position | LMFT
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Name | JENNIFER DOMINGO
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Credential | LMFT
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Telephone | 916-513-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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