Provider Demographics
NPI:1912035775
Name:INSTITUTE FOR GIRLS' DEVELOPMENT
Entity Type:Organization
Organization Name:INSTITUTE FOR GIRLS' DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-585-8075
Mailing Address - Street 1:95 N MARENGO AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1755
Mailing Address - Country:US
Mailing Address - Phone:626-585-8075
Mailing Address - Fax:626-585-0440
Practice Address - Street 1:95 N MARENGO AVE STE 205
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1755
Practice Address - Country:US
Practice Address - Phone:626-585-8075
Practice Address - Fax:626-585-0440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13102103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty