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General NPI Number Information
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NPI Number | 1861176836
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Entity Type | Organization
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Legal Business Name | WINDFALL FAMILY THERAPY PROF CORP
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1891 N GAFFEY ST STE I
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City | SAN PEDRO
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State | CA
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Zip | 90731-1268
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Country | US
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Telephone | 424-264-5288
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Fax | 310-634-0370
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Provider Business Mailing Address
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Address Line | 1891 N GAFFEY ST STE I
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City | SAN PEDRO
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State | CA
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Zip | 90731-1268
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Country | US
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Telephone | 310-621-9687
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Fax | 310-634-0370
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Authorized Official
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Title or Position | CEO
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Name | LORRAINE ROSE IOCOLANO
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Credential | LMFT
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Telephone | 424-264-5288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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