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NPI Code Detail

MEDICARE: AMANDA ALBENO

MEDICARE: AMANDA ALBENO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1225719412
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA ALBENO
Provider Business Mailing Address
First Line : 2544 CLEVELAND AVE STE 204
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2995
Country : US
Telephone Number : 707-308-7050
Fax Number :
Provider Business Practice Location Address
First Line : 2544 CLEVELAND AVE STE 204
Second Line :
City : SANTA ROSA
State : CA
Zip : 95403-2995
Country : US
Telephone Number : 707-308-7050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2023
Last Update Date : 07/31/2023

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Directions to “ AMANDA ALBENO ” Practice Location

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