Healthcare Provider Details

I. General information

NPI: 1326159997
Provider Name (Legal Business Name): PHILIP E CORRADO PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 S FAIR OAKS AVE
PASADENA CA
91105-2621
US

IV. Provider business mailing address

PO BOX 50470
PASADENA CA
91115-0470
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-6200
  • Fax:
Mailing address:
  • Phone: 626-403-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 16628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: