Provider Demographics
NPI:1225686769
Name:IAQUINTO, ELIZABETH (LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:IAQUINTO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 N SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2639
Mailing Address - Country:US
Mailing Address - Phone:559-679-9220
Mailing Address - Fax:
Practice Address - Street 1:420 BULLARD AVE STE E
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1054
Practice Address - Country:US
Practice Address - Phone:559-679-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT149510106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAMF122867OtherBBS