Healthcare Provider Details

I. General information

NPI: 1083400147
Provider Name (Legal Business Name): MORGAN PETRIELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 W 11TH ST
TRACY CA
95376-3821
US

IV. Provider business mailing address

3910 S ORANGE DR
LOS ANGELES CA
90008-1110
US

V. Phone/Fax

Practice location:
  • Phone: 209-318-0760
  • Fax:
Mailing address:
  • Phone: 201-248-2074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number144993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: