Healthcare Provider Details

I. General information

NPI: 1306221429
Provider Name (Legal Business Name): MARCO ANTONIO VITERI LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 CAHUENGA BLVD W STE 335
LOS ANGELES CA
90068-1749
US

IV. Provider business mailing address

1395 KENT PL
GLENDALE CA
91205-2624
US

V. Phone/Fax

Practice location:
  • Phone: 626-765-7841
  • Fax:
Mailing address:
  • Phone: 818-942-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number121920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: