Provider Demographics
NPI:1306274485
Name:DEPETRO, JOANN ADELE (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:JOANN
Middle Name:ADELE
Last Name:DEPETRO
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 1:2099 MT DIABLO BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8495
Mailing Address - Country:US
Mailing Address - Phone:925-945-0167
Mailing Address - Fax:925-945-0346
Practice Address - Street 1:2099 MT DIABLO BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8495
Practice Address - Country:US
Practice Address - Phone:925-945-0167
Practice Address - Fax:925-945-0346
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMS12371106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist