Provider Demographics
NPI:1154697019
Name:NOTO-VENCILL, CARLA J (MA, MFT)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:NOTO-VENCILL
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LOCUST LANE
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9731
Mailing Address - Country:US
Mailing Address - Phone:831-336-0326
Mailing Address - Fax:
Practice Address - Street 1:6265 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9710
Practice Address - Country:US
Practice Address - Phone:408-313-2109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist