MEDICARE: NICHOLAS SHAWN CARFAGNO PH.D.

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	101Y00000X	Counselor
2	103T00000X	Psychologist	PY1047	NV

General Provider Information

NPI Number	:	1487993473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS SHAWN CARFAGNO PH.D.

Provider Business Mailing Address
First Line	:	300 HARVEY WEST BLVD
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-2103
Country	:	US
Telephone Number	:	831-425-8132
Fax Number	:	831-425-4581

Provider Business Practice Location Address
First Line	:	1070 W HORIZON RIDGE PKWY STE 210
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-6020
Country	:	US
Telephone Number	:	702-405-0904
Fax Number	:	702-405-0924

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

Provider Enumeration Date	:	02/11/2013
Last Update Date	:	10/28/2021

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