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General NPI Number Information
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NPI Number | 1255481735
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Entity Type | Individual
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Provider Name | DOMENIC JOHN CARNUCCIO M.A., N.C.C., L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 440 E MARSHALL ST STE 100 EAST MARSHALL STREET MEDICAL CAMPUS
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City | WEST CHESTER
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State | PA
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Zip | 19380-5414
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Country | US
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Telephone | 610-431-2044
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Fax | 610-431-2045
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Provider Business Mailing Address
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Address Line | 316 TASHA LN
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City | COATESVILLE
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State | PA
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Zip | 19320-4260
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Country | US
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Telephone | 610-466-9693
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Fax | 610-431-2045
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC004241
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License Number State | PA
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