Provider Demographics
NPI:1225719958
Name:VINCENTY, CLAUDIO JACK
Entity Type:Individual
Prefix:
First Name:CLAUDIO
Middle Name:JACK
Last Name:VINCENTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 WILLIS AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-2657
Mailing Address - Country:US
Mailing Address - Phone:904-652-3467
Mailing Address - Fax:
Practice Address - Street 1:2716 S VERMONT AVE STE 9
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2594
Practice Address - Country:US
Practice Address - Phone:323-810-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health