Provider Demographics
NPI:1053571950
Name:GEORGETTE, PAMELA LYNN (LMFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:GEORGETTE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 OCEAN PARK BLVD # 107-3
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3301
Mailing Address - Country:US
Mailing Address - Phone:818-813-1621
Mailing Address - Fax:
Practice Address - Street 1:12725 VENTURA BLVD STE G
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2437
Practice Address - Country:US
Practice Address - Phone:818-813-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49940106H00000X
CAMFC 49929106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist