Healthcare Provider Details

I. General information

NPI: 1417313214
Provider Name (Legal Business Name): DEDICATO TREATMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 N ALTADENA DR STE 401
PASADENA CA
91107-7330
US

IV. Provider business mailing address

22 W CARTER AVE
SIERRA MADRE CA
91024-1219
US

V. Phone/Fax

Practice location:
  • Phone: 626-921-0113
  • Fax: 626-921-0214
Mailing address:
  • Phone: 626-921-0113
  • Fax: 626-921-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DR. KEITH LAMONT MARSHALL
Title or Position: C.E.O./CLINICAL DIRECTOR
Credential: PSY.D, M.A.,C.A.T.CV
Phone: 626-921-0113