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Individual

MR. JOHN ANTHONY DEDOMENICO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.S. MFT

Contact information

Practice address
2020 BLAKE ST, BERKELEY, CA 94704
(415) 746-1967
Mailing address
2020 BLAKE ST, BERKELEY, CA 94704-2604
(510) 848-2444

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
MFC 30336
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
30097
BIS
CA
Enumeration date
01/26/2007
Last updated
07/08/2007
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