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General NPI Number Information
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NPI Number | 1255687919
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Entity Type | Organization
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Legal Business Name | EMILIA D. SANTUCCI, FAMILY THERAPIST, A PROFESSIONAL ORGANIZATION
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 203 N 1ST AVE
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City | OAKDALE
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State | CA
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Zip | 95361-3048
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Country | US
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Telephone | 209-845-9037
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Fax | 209-322-3291
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Provider Business Mailing Address
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Address Line | 203 N 1ST AVE
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City | OAKDALE
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State | CA
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Zip | 95361-3048
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Country | US
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Telephone | 209-845-9037
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Fax | 209-322-3291
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Authorized Official
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Title or Position | LICENSED MARRIAGE FAMILY THERAPIST
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Name | MS. EMILIA DESIREE SANTUCCI
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Credential | LMFT
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Telephone | 209-605-2591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC39006
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License Number State | CA
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