MEDICARE: DR. ANTOINETTE MARIE KATHOL IBRAHIMI PSY.D.

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
1	103TC0700X	Clinical Psychologist	PSY27466	CA

General Provider Information

NPI Number	:	1871720813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTOINETTE MARIE KATHOL IBRAHIMI PSY.D.

Provider Business Mailing Address
First Line	:	PO BOX 5501
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91117-0501
Country	:	US
Telephone Number	:	626-818-8327
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 N INDIAN HILL BLVD
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-4614
Country	:	US
Telephone Number	:	626-470-7792
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	10/15/2025

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