Healthcare Provider Details

I. General information

NPI: 1255475653
Provider Name (Legal Business Name): JOANNA DENISE CAIN ED.D. ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA DENISE CAIN EDD

II. Dates (important events)

Enumeration Date: 02/18/2007
Last Update Date: 05/19/2023
Certification Date: 05/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 LONG BEACH BLVD
LONG BEACH CA
90807-5062
US

IV. Provider business mailing address

1820 W FLORENCE AVE
LOS ANGELES CA
90047-2123
US

V. Phone/Fax

Practice location:
  • Phone: 562-548-6565
  • Fax:
Mailing address:
  • Phone: 310-428-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number139344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: