Provider Demographics
NPI:1134280092
Name:CICCHETTO, THERESA LOUISE (MFT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LOUISE
Last Name:CICCHETTO
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 1:330 ANCHORAGE DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7896
Mailing Address - Country:US
Mailing Address - Phone:707-514-5812
Mailing Address - Fax:707-474-9531
Practice Address - Street 1:292 ALAMO DR STE 3
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4243
Practice Address - Country:US
Practice Address - Phone:707-514-5812
Practice Address - Fax:707-422-3302
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist