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NPI Code Detail

MEDICARE: MEGAN MARIE LACCONE

MEDICARE: MEGAN MARIE LACCONE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1134750870
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN MARIE LACCONE
Provider Business Mailing Address
First Line : 4775 VIEWRIDGE AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1641
Country : US
Telephone Number : 858-285-8083
Fax Number :
Provider Business Practice Location Address
First Line : 4775 VIEWRIDGE AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-1641
Country : US
Telephone Number : 858-285-8083
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2020
Last Update Date : 03/08/2024

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