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6622 3rd Street Riverbank CA 95367-2304 | |
| (209) 502-7373 | |
| (209) 269-3225 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 6622 3rd Street, Riverbank, California |
| Authorized Official Name and Position | Sonia Ramirez Andalon (CEO/ THERAPIST) |
| Authorized Official Contact | 2095027373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
6622 3rd Street Riverbank CA 95367-2304 Ph: (209) 502-7373 | 6622 3rd Street Riverbank CA 95367-2304 Ph: (209) 502-7373 |
| NPI Number | 1588299242 |
|---|---|
| Provider Enumeration Date | 03/03/2020 |
| Last Update Date | 05/23/2024 |
| Certification Date | 05/23/2024 |
| Medicare PECOS PAC ID | 3971044157 |
|---|---|
| Medicare Enrollment ID | O20240916003377 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588299242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP2701X | Psychologist - Group Psychotherapy | (* (Not Available)) | Secondary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Jose A Torres Andalon |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1790918050 PECOS PAC ID: 4587104740 Enrollment ID: I20241001000787 |
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