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NPI Code Detail

MEDICARE: DAMON JOSEPH MAGGIORE MS, LMFT, LPT

MEDICARE: DAMON JOSEPH MAGGIORE MS, LMFT, LPT
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
1167G00000XLicensed Psychiatric Technician30405CA
2106H00000XMarriage & Family Therapist44475CA

General Provider Information

NPI Number : 1417016247
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMON JOSEPH MAGGIORE MS, LMFT, LPT
Provider Business Mailing Address
First Line : PO BOX 5052
Second Line :
City : PASO ROBLES
State : CA
Zip : 93447-5052
Country : US
Telephone Number : 805-801-7947
Fax Number : 805-237-3170
Provider Business Practice Location Address
First Line : 2945 MCMILLAN AVE STE 240
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401
Country : US
Telephone Number : 805-439-4893
Fax Number : 805-439-4891
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2006
Last Update Date : 08/08/2018

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