Healthcare Provider Details

I. General information

NPI: 1699007591
Provider Name (Legal Business Name): ADRIENNE ELIZABETH PASEK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8941 ATLANTA AVE STE 319
HUNTINGTON BEACH CA
92646-7121
US

IV. Provider business mailing address

8941 ATLANTA AVE STE 319
HUNTINGTON BEACH CA
92646-7121
US

V. Phone/Fax

Practice location:
  • Phone: 949-201-5779
  • Fax: 877-209-7251
Mailing address:
  • Phone: 949-201-5779
  • Fax: 877-209-7251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number23321
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number23321
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number23321
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number23321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: