Basic Information
| Provider Information | |||||||||
| NPI: | 1124315635 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMO | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | BA, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14601 BALDWIN AVE | ||||||||
| Address2: | |||||||||
| City: | BALDWIN PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917061739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266752440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2226 E RIO VERDE DR | ||||||||
| Address2: | |||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917912067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263321367 | ||||||||
| FaxNumber: | 6263320857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 07/06/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF62109 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IMF62109 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.