Provider Demographics
NPI:1447696901
Name:KISLINGER, RAQUEL TAMAR (MA)
Entity type:Individual
Prefix:MRS
First Name:RAQUEL
Middle Name:TAMAR
Last Name:KISLINGER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:95 NORTH MARENGO AVENUE, SUITE 100
Mailing Address - Street 2:INSTITUTE FOR GIRLS' DEVELOPMENT
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101
Mailing Address - Country:US
Mailing Address - Phone:626-585-8075
Mailing Address - Fax:626-585-0440
Practice Address - Street 1:95 NORTH MARENGO AVENUE, SUITE 100
Practice Address - Street 2:INSTITUTE FOR GIRLS' DEVELOPMENT
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-585-8075
Practice Address - Fax:626-585-0440
Is Sole Proprietor?:No
Enumeration Date:2013-05-10
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT83601106H00000X
CAMFTI 64036106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist