Provider Demographics
NPI:1972335784
Name:EVERGREEN EDUCATIONAL THERAPY LLC
Entity type:Organization
Organization Name:EVERGREEN EDUCATIONAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPORE
Authorized Official - Suffix:
Authorized Official - Credentials:ET/P
Authorized Official - Phone:626-977-4211
Mailing Address - Street 1:709 E COLORADO BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2159
Mailing Address - Country:US
Mailing Address - Phone:626-214-8972
Mailing Address - Fax:626-517-5083
Practice Address - Street 1:709 E COLORADO BLVD STE 250
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2159
Practice Address - Country:US
Practice Address - Phone:626-214-8972
Practice Address - Fax:626-517-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty