Healthcare Provider Details

I. General information

NPI: 1982120499
Provider Name (Legal Business Name): TEREZA TOLEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 09/26/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E FOOTHILL BLVD FL 2ND
PASADENA CA
91107-3148
US

IV. Provider business mailing address

3280 E FOOTHILL BLVD FL 2N
PASADENA CA
91107-3148
US

V. Phone/Fax

Practice location:
  • Phone: 877-608-0044
  • Fax:
Mailing address:
  • Phone: 877-608-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW83233
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW83233
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW102091
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW102091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: