Provider Demographics
NPI:1154978385
Name:ST GEORGE, REBECCA GIORDANO (LMFT CA 28030)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:GIORDANO
Last Name:ST GEORGE
Suffix:
Gender:F
Credentials:LMFT CA 28030
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:PITTS
Other - Last Name:GIORDANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT CA 28030
Mailing Address - Street 1:390 SPAR AVENUE SUITE 106
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117
Mailing Address - Country:US
Mailing Address - Phone:408-261-2481
Mailing Address - Fax:408-241-9808
Practice Address - Street 1:390 SPAR AVENUE SUITE 106
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117
Practice Address - Country:US
Practice Address - Phone:408-261-2481
Practice Address - Fax:408-241-9808
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT28030106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty