Carolyn Detierra, MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

45053 Issued in CA

Practice address

480 Tesconi Cir Ste B
Santa Rosa, CA 95401-4691

Phone

(707) 583-1456

NPI assigned

Jul 1, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652918400000",
    "number": "1780090571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1958 ALAMO LN",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954078908",
            "telephone_number": "707-888-7519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 TESCONI CIR STE B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014691",
            "telephone_number": "707-583-1456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETIERRA",
        "first_name": "CAROLYN",
        "credential": "MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-07-01",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "45053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Audrey B. Desky, MD
• Vanessa Lee Desousa, D.O.
• Andrew James Desruisseau, M.D.
• Jamie Detels, LVN
• Sarah Marie Determan, PHD
• Renee Dettloff, CNM
• Dixie Lee Deuth
• Charlynn Devenny, RASI
• Maureen Ann Devine, MFC
• Patrick Devlin, MD

• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.