Provider Demographics
NPI:1306542923
Name:ANDERSON, GERALD EDWARD (LMFT)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:EDWARD
Last Name:ANDERSON
Suffix:
Gender:M
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:PO BOX 3112
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91031-6112
Mailing Address - Country:US
Mailing Address - Phone:818-437-7621
Mailing Address - Fax:
Practice Address - Street 1:5534 MARSHBURN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5713
Practice Address - Country:US
Practice Address - Phone:818-437-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty