Healthcare Provider Details

I. General information

NPI: 1104376011
Provider Name (Legal Business Name): JANE CUNHA MA, PCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 10/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E DEL MAR BLVD SUITE 119
PASADENA CA
91105-2544
US

IV. Provider business mailing address

4200 VIA ARBOLADA #223
LOS ANGELES CA
90042-5000
US

V. Phone/Fax

Practice location:
  • Phone: 203-927-2221
  • Fax:
Mailing address:
  • Phone: 203-927-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPCCI722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: