Healthcare Provider Details

I. General information

NPI: 1235785395
Provider Name (Legal Business Name): PEDROSO PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 02/05/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 N TATUM BLVD STE 300
PHOENIX AZ
85028-6039
US

IV. Provider business mailing address

11201 N TATUM BLVD STE 300
PHOENIX AZ
85028-6039
US

V. Phone/Fax

Practice location:
  • Phone: 480-310-8090
  • Fax:
Mailing address:
  • Phone: 480-310-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIELLA PEDROSO
Title or Position: OWNER
Credential: PSY.D.
Phone: 480-310-8090