Healthcare Provider Details

I. General information

NPI: 1295010023
Provider Name (Legal Business Name): JOSEPH LIDO PETRONI II LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SCENIC DR BUILDING D
MODESTO CA
95350-6131
US

IV. Provider business mailing address

800 SCENIC DR BLDG D
MODESTO CA
95350-6131
US

V. Phone/Fax

Practice location:
  • Phone: 209-525-6070
  • Fax:
Mailing address:
  • Phone: 209-525-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number99187
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1971077
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: