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NPI Code Detail

MEDICARE: IRENE SUSAN PINES LMFT

MEDICARE: IRENE SUSAN PINES LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC23131CA

General Provider Information

NPI Number : 1174662993
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRENE SUSAN PINES LMFT
Provider Business Mailing Address
First Line : 2550 E FOOTHILL BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-3406
Country : US
Telephone Number : 626-744-5230
Fax Number : 626-744-5242
Provider Business Practice Location Address
First Line : 2550 E FOOTHILL BLVD
Second Line :
City : PASADENA
State : CA
Zip : 91107-3406
Country : US
Telephone Number : 626-744-5230
Fax Number : 626-744-5242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 07/08/2007

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