Provider Demographics
NPI:1710456777
Name:MATTIELLO, CHELSEA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:MATTIELLO
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 VARIEL AVE APT 425
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4807
Mailing Address - Country:US
Mailing Address - Phone:310-968-8784
Mailing Address - Fax:
Practice Address - Street 1:6710 VARIEL AVE APT 425
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4807
Practice Address - Country:US
Practice Address - Phone:310-968-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist