Provider Demographics
NPI:1790213247
Name:PASADENA CLINICAL GROUP, A PSYCHOLOGY CORPORATION
Entity Type:Organization
Organization Name:PASADENA CLINICAL GROUP, A PSYCHOLOGY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VINCENZO
Authorized Official - Middle Name:ISRAEL
Authorized Official - Last Name:PICCIRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-354-6440
Mailing Address - Street 1:PO BOX 5581
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91117-0581
Mailing Address - Country:US
Mailing Address - Phone:626-354-6440
Mailing Address - Fax:805-456-5547
Practice Address - Street 1:595 E COLORADO BLVD STE 428
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2058
Practice Address - Country:US
Practice Address - Phone:626-354-6440
Practice Address - Fax:805-456-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty