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NPI Code Detail

MEDICARE: MR. NICHOLAS ANTHONY PITACCIO LMFT

MEDICARE:  MR. NICHOLAS ANTHONY PITACCIO  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
1106H00000XMarriage & Family Therapist53332CA

General Provider Information

NPI Number : 1558387613
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NICHOLAS ANTHONY PITACCIO LMFT
Provider Business Mailing Address
First Line : 1955 LONG BEACH BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-5501
Country : US
Telephone Number : 562-673-9288
Fax Number :
Provider Business Practice Location Address
First Line : 1955 LONG BEACH BLVD
Second Line :
City : LONG BEACH
State : CA
Zip : 90806-5501
Country : US
Telephone Number : 562-437-6717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 11/20/2020

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Directions to “ MR. NICHOLAS ANTHONY PITACCIO LMFT” Practice Location

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