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General NPI Number Information
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NPI Number | 1528214889
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Entity Type | Individual
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Provider Name | DANA PUTNAM FONTENEAU M.M., M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 315 SANCHEZ ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-1615
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Country | US
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Telephone | 415-820-1691
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Fax |
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Provider Business Mailing Address
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Address Line | 776 GRIZZLY PEAK BLVD
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City | BERKELEY
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State | CA
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Zip | 94708-1337
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Country | US
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Telephone | 510-847-3884
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMF 54561
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License Number State | CA
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