Healthcare Provider Details

I. General information

NPI: 1225953490
Provider Name (Legal Business Name): JON-PATRIK PEDERSEN, PHD, CLINICAL PSYCHOLOGY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 N MADISON AVE
PASADENA CA
91101-1710
US

IV. Provider business mailing address

102 N MADISON AVE
PASADENA CA
91101-1710
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-4737
  • Fax:
Mailing address:
  • Phone: 626-449-4737
  • 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

VIII. Authorized Official

Name: DR. JOHN PATRICK PEDERSEN
Title or Position: CLINICAL PSYCHOLOGIST
Credential:
Phone: 626-449-4737