Provider Demographics
NPI:1316375322
Name:BORNSTEIN, LINDY MARCIA GECHT
Entity Type:Individual
Prefix:
First Name:LINDY
Middle Name:MARCIA GECHT
Last Name:BORNSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W LEMON AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5112
Mailing Address - Country:US
Mailing Address - Phone:626-993-0636
Mailing Address - Fax:626-466-9448
Practice Address - Street 1:50 W LEMON AVE STE 4
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016
Practice Address - Country:US
Practice Address - Phone:626-993-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 75023106H00000X
CA96327106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist