Provider Demographics
NPI:1215034012
Name:FANUCCHI, STEVEN MICHAEL (MFT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:FANUCCHI
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 1:35552 PALOMARES RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-9631
Mailing Address - Country:US
Mailing Address - Phone:510-886-5391
Mailing Address - Fax:
Practice Address - Street 1:3775 BEACON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1465
Practice Address - Country:US
Practice Address - Phone:510-792-4964
Practice Address - Fax:510-792-4928
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35555106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist