Provider Demographics
NPI:1083087191
Name:PETITTI, MARIE ANTONETTE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ANTONETTE
Last Name:PETITTI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S CITRUS AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2686
Mailing Address - Country:US
Mailing Address - Phone:714-733-3115
Mailing Address - Fax:626-915-7588
Practice Address - Street 1:100 S CITRUS AVE STE 206
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2686
Practice Address - Country:US
Practice Address - Phone:714-733-3115
Practice Address - Fax:626-915-7588
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41451106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist