Provider Demographics
NPI:1811231251
Name:AVINCOLA, MASSIMO (MA, MFT)
Entity Type:Individual
Prefix:MR
First Name:MASSIMO
Middle Name:
Last Name:AVINCOLA
Suffix:
Gender:M
Credentials:MA, MFT
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 46
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-0046
Mailing Address - Country:US
Mailing Address - Phone:310-425-2024
Mailing Address - Fax:
Practice Address - Street 1:11500 W OLYMPIC BLVD
Practice Address - Street 2:STE. 420
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1524
Practice Address - Country:US
Practice Address - Phone:310-425-2024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist