Provider Demographics
NPI:1417016247
Name:MAGGIORE, DAMON JOSEPH (MS, LMFT, LPT)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:JOSEPH
Last Name:MAGGIORE
Suffix:
Gender:M
Credentials:MS, LMFT, LPT
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 5052
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93447-5052
Mailing Address - Country:US
Mailing Address - Phone:805-801-7947
Mailing Address - Fax:805-237-3170
Practice Address - Street 1:2945 MCMILLAN AVE STE 240
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-439-4893
Practice Address - Fax:805-439-4891
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30405167G00000X
CA44475106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No167G00000XNursing Service ProvidersLicensed Psychiatric Technician