Healthcare Provider Details

I. General information

NPI: 1265396964
Provider Name (Legal Business Name): JOSEPH ANGELO DECECCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 S HALCYON RD STE 101
ARROYO GRANDE CA
93420-3174
US

IV. Provider business mailing address

1340 BELLO ST
PISMO BEACH CA
93449-2320
US

V. Phone/Fax

Practice location:
  • Phone: 805-801-2231
  • Fax:
Mailing address:
  • Phone: 717-364-8419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: