MEDICARE: MR. NICHOLAS JOSEPH FITTANTE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC27161	CA

General Provider Information

NPI Number	:	1235238783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS JOSEPH FITTANTE LMFT

Provider Business Mailing Address
First Line	:	2545 S EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-6620
Country	:	US
Telephone Number	:	909-983-5575
Fax Number	:	909-983-1076

Provider Business Practice Location Address
First Line	:	2545 S EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-6620
Country	:	US
Telephone Number	:	909-983-5575
Fax Number	:	909-983-1076

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	02/19/2019

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