Provider Demographics
NPI:1164524906
Name:BARTOLOTTI, DARRYL EUGENE (MFT)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:EUGENE
Last Name:BARTOLOTTI
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 S 2ND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3532
Mailing Address - Country:US
Mailing Address - Phone:626-858-2864
Mailing Address - Fax:626-858-2865
Practice Address - Street 1:636 S 2ND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3532
Practice Address - Country:US
Practice Address - Phone:626-858-2864
Practice Address - Fax:626-858-2865
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37192106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist