Provider Demographics
NPI:1548870728
Name:DR. SUPATRA TOVAR & ASSOCIATES, A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:DR. SUPATRA TOVAR & ASSOCIATES, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUPATRA
Authorized Official - Middle Name:H
Authorized Official - Last Name:TOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, RD
Authorized Official - Phone:626-674-2639
Mailing Address - Street 1:301 N LAKE AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-5129
Mailing Address - Country:US
Mailing Address - Phone:626-674-2639
Mailing Address - Fax:
Practice Address - Street 1:301 N LAKE AVE STE 600
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-5129
Practice Address - Country:US
Practice Address - Phone:626-674-2639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-03
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty