Provider Demographics
NPI:1487993473
Name:CARFAGNO, NICHOLAS SHAWN (PHD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SHAWN
Last Name:CARFAGNO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARVEY WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2103
Mailing Address - Country:US
Mailing Address - Phone:831-425-8132
Mailing Address - Fax:831-425-4581
Practice Address - Street 1:1070 W HORIZON RIDGE PKWY STE 210
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-6020
Practice Address - Country:US
Practice Address - Phone:702-405-0904
Practice Address - Fax:702-405-0924
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NVPY1047103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor