Provider Demographics
NPI:1427882364
Name:PINEDALE PSYCHOLOGY, PC
Entity type:Organization
Organization Name:PINEDALE PSYCHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:REINECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:818-274-2227
Mailing Address - Street 1:1808 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1910
Mailing Address - Country:US
Mailing Address - Phone:818-274-2227
Mailing Address - Fax:
Practice Address - Street 1:715 N CENTRAL AVE STE 108
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1225
Practice Address - Country:US
Practice Address - Phone:818-274-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty