Provider Demographics
NPI:1720045248
Name:CIOLINO, JOSETTE MARIE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JOSETTE
Middle Name:MARIE
Last Name:CIOLINO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 6TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3345
Mailing Address - Country:US
Mailing Address - Phone:310-971-1868
Mailing Address - Fax:310-707-2501
Practice Address - Street 1:222 W 6TH ST # 459
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3316
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18122103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCP18122Medicare UPIN
CAPSY18122Medicare ID - Type Unspecified