Healthcare Provider Details

I. General information

NPI: 1912860180
Provider Name (Legal Business Name): ANTHONY FAGGIOLI IV AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 N VERDUGO RD UNIT 318
GLENDALE CA
91208-2128
US

IV. Provider business mailing address

2940 N VERDUGO RD UNIT 318
GLENDALE CA
91208-2128
US

V. Phone/Fax

Practice location:
  • Phone: 818-814-8270
  • Fax:
Mailing address:
  • Phone: 818-814-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT159541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: