Provider Demographics
NPI:1861542995
Name:CARNUCCIO COUNSELING LLC
Entity type:Organization
Organization Name:CARNUCCIO COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CARNUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, NCC, LPC
Authorized Official - Phone:610-431-2044
Mailing Address - Street 1:316 TASHA LN
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-4260
Mailing Address - Country:US
Mailing Address - Phone:610-466-9693
Mailing Address - Fax:610-431-2045
Practice Address - Street 1:440 EAST MARSHALL STREET MEDICAL CAMPUS
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5414
Practice Address - Country:US
Practice Address - Phone:610-431-2044
Practice Address - Fax:610-431-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty