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General NPI Number Information
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NPI Number | 1427693050
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Entity Type | Individual
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Provider Name | EILEEN LOUISE DEGRUCCIO LMFT
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 2377 GOLD MEADOW WAY STE 100
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City | GOLD RIVER
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State | CA
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Zip | 95670-4444
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Country | US
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Telephone | 916-206-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 9029 ERLE BLUNDEN WAY
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City | FAIR OAKS
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State | CA
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Zip | 95628-8160
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Country | US
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Telephone | 916-206-7003
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Fax |
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 31090
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License Number State | CA
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