Provider Demographics
NPI:1699254466
Name:NATOLI, JUSTIN
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:NATOLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 OLMSTED AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2628
Mailing Address - Country:US
Mailing Address - Phone:310-508-2590
Mailing Address - Fax:
Practice Address - Street 1:822 S ROBERTSON BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1632
Practice Address - Country:US
Practice Address - Phone:310-508-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-12
Last Update Date:2018-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88839106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty