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General NPI Number Information
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NPI Number | 1497553861
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Entity Type | Individual
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Provider Name | NICOLE MENOLASCINO
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Gender | Female
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 1968 S COAST HWY # 634
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-3681
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Country | US
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Telephone | 619-547-1856
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Fax |
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Provider Business Mailing Address
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Address Line | 25717 STAFFORD CANYON RD
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City | STEVENSON RANCH
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State | CA
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Zip | 91381-1525
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Country | US
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Telephone | 661-644-9628
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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 | AMFT149283
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License Number State | CA
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