Provider Demographics
NPI:1205996709
Name:LEWIS PIGNATARO, SUSAN MARIA (MFT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIA
Last Name:LEWIS PIGNATARO
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:PO BOX 2002
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-2002
Mailing Address - Country:US
Mailing Address - Phone:707-815-9159
Mailing Address - Fax:
Practice Address - Street 1:454 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6519
Practice Address - Country:US
Practice Address - Phone:707-815-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC25062106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist