Provider Demographics
NPI:1821556655
Name:VATTUONE, RICHARD CHRISTIAN (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHRISTIAN
Last Name:VATTUONE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 TRUXTUN RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6135
Mailing Address - Country:US
Mailing Address - Phone:858-642-1500
Mailing Address - Fax:
Practice Address - Street 1:201 9TH ST
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6039
Practice Address - Country:US
Practice Address - Phone:831-884-1000
Practice Address - Fax:831-884-1002
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW872921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical