MEDICARE: JAMES SHEPPARD STEINWEDELL M.DIV., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	MFT 25176	CA
2	106H00000X	Marriage & Family Therapist	MFT 25176	CA

General Provider Information

NPI Number	:	1144543406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES SHEPPARD STEINWEDELL M.DIV., PH.D.

Provider Business Mailing Address
First Line	:	462 S MARENGO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3129
Country	:	US
Telephone Number	:	626-577-5587
Fax Number	:

Provider Business Practice Location Address
First Line	:	462 S MARENGO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-3129
Country	:	US
Telephone Number	:	626-577-5587
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2010
Last Update Date	:	03/01/2010

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