Provider Demographics
NPI:1750133609
Name:MAGGI, MARCO ROBERT (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ROBERT
Last Name:MAGGI
Suffix:
Gender:M
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11232 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2909
Mailing Address - Country:US
Mailing Address - Phone:562-739-0422
Mailing Address - Fax:
Practice Address - Street 1:11232 KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2909
Practice Address - Country:US
Practice Address - Phone:562-739-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15938101Y00000X
CA145248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor