Healthcare Provider Details

I. General information

NPI: 1386878593
Provider Name (Legal Business Name): ERIN K.S. MARCEL IMF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN KISSA SNEED IMF

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S DE LACEY AVE STE 110
PASADENA CA
91105-2048
US

IV. Provider business mailing address

210 S DE LACEY AVE STE 110
PASADENA CA
91105-2048
US

V. Phone/Fax

Practice location:
  • Phone: 626-395-7100
  • Fax:
Mailing address:
  • Phone: 626-395-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF74971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: