Healthcare Provider Details

I. General information

NPI: 1346618386
Provider Name (Legal Business Name): LISETTE PINEDO LCSW #89127
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 10/27/2023
Certification Date: 07/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 W GARVEY AVE N
WEST COVINA CA
91790-2138
US

IV. Provider business mailing address

PO BOX 4256
EL MONTE CA
91734-0256
US

V. Phone/Fax

Practice location:
  • Phone: 626-960-4844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW89127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: