Basic Information
| Provider Information | |||||||||
| NPI: | 1093839607 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PASADENA UNIFIED SCHOOL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PUSD MENTAL HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2046 N. ALLEN AVE | ||||||||
| Address2: | |||||||||
| City: | ALTADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910013424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263965920 | ||||||||
| FaxNumber: | 6267916251 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 N RAYMOND AVE BLDG 2-7 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911031819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263965920 | ||||||||
| FaxNumber: | 6267916251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 04/07/2020 | ||||||||
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| AuthorizedOfficialLastName: | VILLALPANDO | ||||||||
| AuthorizedOfficialFirstName: | ERICA | ||||||||
| AuthorizedOfficialMiddleName: | KARLINE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6263965920 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | LCSW 27714 | ||||||||
| NPICertificationDate: | 04/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | CA | Y | Agencies | Local Education Agency (LEA) |
ID Information
| ID | Type | State | Issuer | Description | 7567 | 01 | CA | MEDI-CAL PROVIDER NUMBER | OTHER |