Provider Demographics
NPI:1992492417
Name:UCCELLO., PAIGHTEN MADISON JEAN
Entity type:Individual
Prefix:
First Name:PAIGHTEN
Middle Name:MADISON JEAN
Last Name:UCCELLO.
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 MARVEL AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2211
Mailing Address - Country:US
Mailing Address - Phone:208-220-1695
Mailing Address - Fax:
Practice Address - Street 1:2195 MARVEL AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2211
Practice Address - Country:US
Practice Address - Phone:208-220-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician