Provider Demographics
NPI:1518485374
Name:AVITABILE, JOHN L (LMFT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:AVITABILE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 SEASHORE DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2929
Mailing Address - Country:US
Mailing Address - Phone:949-254-3790
Mailing Address - Fax:
Practice Address - Street 1:3803 SEASHORE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2929
Practice Address - Country:US
Practice Address - Phone:949-254-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100281106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist