Provider Demographics
NPI:1013102011
Name:LUNDGREN, MEGAN EILEEN
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:EILEEN
Last Name:LUNDGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 WEMBLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-1940
Mailing Address - Country:US
Mailing Address - Phone:626-318-5014
Mailing Address - Fax:
Practice Address - Street 1:1390 WEMBLEY RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1940
Practice Address - Country:US
Practice Address - Phone:626-318-5014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist