Provider Demographics
NPI:1275915654
Name:CUOMO, MITCHELL MARC (LCSW)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:MARC
Last Name:CUOMO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 MISSION AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7110
Mailing Address - Country:US
Mailing Address - Phone:760-712-3535
Mailing Address - Fax:760-439-6901
Practice Address - Street 1:1701 MISSION AVE # 230
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058
Practice Address - Country:US
Practice Address - Phone:760-712-3535
Practice Address - Fax:760-439-6901
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW948801041C0700X
CAASW78186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health