Healthcare Provider Details

I. General information

NPI: 1407933005
Provider Name (Legal Business Name): PAMELA SUE PINE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD STE 212
BEVERLY HILLS CA
90212-2102
US

IV. Provider business mailing address

9735 WILSHIRE BLVD STE 212
BEVERLY HILLS CA
90212-2102
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-1867
  • Fax: 310-275-4838
Mailing address:
  • Phone: 310-275-1867
  • Fax: 310-275-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY16970
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY16970
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY16970
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY16970
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY6970
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY16970
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY16970
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT17040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: