Provider Demographics
NPI:1710551296
Name:FITTANTE, RAECHEL ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:RAECHEL
Middle Name:ANN
Last Name:FITTANTE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 S EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-6620
Mailing Address - Country:US
Mailing Address - Phone:909-983-5575
Mailing Address - Fax:909-983-1076
Practice Address - Street 1:2545 S EUCLID AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6620
Practice Address - Country:US
Practice Address - Phone:909-983-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124761106H00000X
CA137720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist