Basic Information
| Provider Information | |||||||||
| NPI: | 1235238783 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITTANTE | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2545 S EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917626620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099835575 | ||||||||
| FaxNumber: | 9099831076 | ||||||||
| Practice Location | |||||||||
| Address1: | 2545 S EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917626620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099835575 | ||||||||
| FaxNumber: | 9099831076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC27161 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.