Provider Demographics
NPI:1689007304
Name:SHAIN, BEATRICE ANDREA (MA)
Entity Type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:ANDREA
Last Name:SHAIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:BEATRICE BETINA
Other - Middle Name:ANDREA
Other - Last Name:SHAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:620 N LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1220
Mailing Address - Country:US
Mailing Address - Phone:626-793-7350
Mailing Address - Fax:626-793-7341
Practice Address - Street 1:620 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1220
Practice Address - Country:US
Practice Address - Phone:626-793-7350
Practice Address - Fax:626-793-7341
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30953106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist