Healthcare Provider Details

I. General information

NPI: 1952079048
Provider Name (Legal Business Name): ANNETTE LARRANAGA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 MADISON AVE
ALTADENA CA
91001-3016
US

IV. Provider business mailing address

2014 MADISON AVE
ALTADENA CA
91001-3016
US

V. Phone/Fax

Practice location:
  • Phone: 626-687-2436
  • Fax:
Mailing address:
  • Phone: 626-687-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154803
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberAMFT138478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: