Provider Demographics
NPI:1083362057
Name:PETROSY, BRITTNI NICOLE
Entity Type:Individual
Prefix:
First Name:BRITTNI
Middle Name:NICOLE
Last Name:PETROSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91012-5233
Mailing Address - Country:US
Mailing Address - Phone:626-708-0442
Mailing Address - Fax:
Practice Address - Street 1:850 COLORADO BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90041-1733
Practice Address - Country:US
Practice Address - Phone:323-451-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC11163101YP2500X
CAAMFT128609106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional