1861542995 NPI number — CARNUCCIO COUNSELING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861542995 NPI number — CARNUCCIO COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARNUCCIO COUNSELING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861542995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 TASHA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COATESVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19320-4260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-466-9693
Provider Business Mailing Address Fax Number:
610-431-2045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 EAST MARSHALL STREET MEDICAL CAMPUS
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19380-5414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-431-2044
Provider Business Practice Location Address Fax Number:
610-431-2045
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARNUCCIO
Authorized Official First Name:
DOMENIC
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
610-431-2044

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC004241 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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