Provider Demographics
NPI:1326593211
Name:PASADENA UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PASADENA UNIFIED SCHOOL DISTRICT
Other - Org Name:PUSD MENTAL HEALTH SERVICES FPA
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-396-5920
Mailing Address - Street 1:1520 N. RAYMOND AVE.
Mailing Address - Street 2:BLDGS. 2-7
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103
Mailing Address - Country:US
Mailing Address - Phone:626-396-5920
Mailing Address - Fax:626-791-6251
Practice Address - Street 1:3126 GLENROSE AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-4328
Practice Address - Country:US
Practice Address - Phone:626-396-5950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASADENA UNIFIED SCHOOL DISTICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-20
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000007567OtherMEDI-CAL PROVIDER ID