Healthcare Provider Details

I. General information

NPI: 1932584539
Provider Name (Legal Business Name): PAUL K CHITWOOD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4811 CHIPPENDALE DR # 302
SACRAMENTO CA
95841-2555
US

IV. Provider business mailing address

4811 CHIPPENDALE DR # 302
SACRAMENTO CA
95841-2555
US

V. Phone/Fax

Practice location:
  • Phone: 916-349-9403
  • Fax:
Mailing address:
  • Phone: 916-349-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY14963
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14963
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY14963
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: