Healthcare Provider Details

I. General information

NPI: 1427885367
Provider Name (Legal Business Name): MICHAEL A DEPINTO AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 E COLORADO BLVD STE 517
PASADENA CA
91101-2017
US

IV. Provider business mailing address

595 E COLORADO BLVD STE 517
PASADENA CA
91101-2017
US

V. Phone/Fax

Practice location:
  • Phone: 424-234-9696
  • Fax:
Mailing address:
  • Phone: 310-876-2089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number146719
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: