Basic Information
| Provider Information | |||||||||
| NPI: | 1245608082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLETELLO | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24275 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925627285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516775599 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 E CHAPMAN AVE STE 203 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928313846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146809000 | ||||||||
| FaxNumber: | 7146808233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2015 | ||||||||
| LastUpdateDate: | 10/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.