Doctor Name: | TODD CIRILLO |
NPI Number: | 1093081051 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BSW |
License Number: | |
Business Practice Address: | 202 Providence Mine Rd Suite 105 Nevada City, CA - 959592947 |
Business Phone Number: | 5302657844 |
Business Fax Number: | |
Mailing Address: | 202 Providence Mine Rd, Suite 105 NEVADA CITY |
State: | CA |
Postal Code: | 959592947 |
Phone Number: | 5302657844 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2012 |
NPI Last Update Date: | 03/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |