Healthcare Provider Details

I. General information

NPI: 1124996566
Provider Name (Legal Business Name): NICOLETTE CAUTERO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 W 39TH ST
SAN PEDRO CA
90731-7004
US

IV. Provider business mailing address

PO BOX 812
PALOS VERDES ESTATES CA
90274-0812
US

V. Phone/Fax

Practice location:
  • Phone: 323-688-6610
  • Fax:
Mailing address:
  • Phone: 323-688-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT147092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: