Provider Demographics
NPI:1548395817
Name:PESAPANE, GINA MARIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:MARIE
Last Name:PESAPANE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 S LUCIA AVE
Mailing Address - Street 2:APT #3
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3509
Mailing Address - Country:US
Mailing Address - Phone:310-892-0417
Mailing Address - Fax:310-328-0175
Practice Address - Street 1:3814 DUNN DR
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2735
Practice Address - Country:US
Practice Address - Phone:310-892-0417
Practice Address - Fax:310-328-0175
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52399106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist