Provider Demographics
NPI:1093839607
Name:PASADENA UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PASADENA UNIFIED SCHOOL DISTRICT
Other - Org Name:PUSD MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:KARLINE
Authorized Official - Last Name:VILLALPANDO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW 27714
Authorized Official - Phone:626-396-5920
Mailing Address - Street 1:2046 N. ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-3424
Mailing Address - Country:US
Mailing Address - Phone:626-396-5920
Mailing Address - Fax:626-791-6251
Practice Address - Street 1:1520 N RAYMOND AVE BLDG 2-7
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1819
Practice Address - Country:US
Practice Address - Phone:626-396-5920
Practice Address - Fax:626-791-6251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7567OtherMEDI-CAL PROVIDER NUMBER