Provider Demographics
NPI:1780831875
Name:RASAK, PAMELA JEAN (MFT)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:RASAK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:RASAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1830 LINCOLN BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-4524
Mailing Address - Country:US
Mailing Address - Phone:310-485-5683
Mailing Address - Fax:
Practice Address - Street 1:1830 LINCOLN BLVD
Practice Address - Street 2:STE 109
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-485-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health