Provider Demographics
NPI:1427585264
Name:GOTTUSO, NICOLETTE CHRISTINE
Entity Type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:CHRISTINE
Last Name:GOTTUSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4929
Mailing Address - Country:US
Mailing Address - Phone:650-815-5391
Mailing Address - Fax:
Practice Address - Street 1:16 RITTER ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3323
Practice Address - Country:US
Practice Address - Phone:650-815-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)