Provider Demographics
NPI:1386967560
Name:PESAVENTO, LORI JEAN (MFT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:PESAVENTO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2920
Mailing Address - Country:US
Mailing Address - Phone:707-255-0966
Mailing Address - Fax:707-255-0966
Practice Address - Street 1:709 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2920
Practice Address - Country:US
Practice Address - Phone:707-255-0966
Practice Address - Fax:707-255-0966
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT29202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist