Healthcare Provider Details

I. General information

NPI: 1083992390
Provider Name (Legal Business Name): JOYCE W CORDOSI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CALIFORNIA DRIVE
VACAVILLE CA
95696
US

IV. Provider business mailing address

PO BOX 348074
SACRAMENTO CA
95834-8074
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-6841
  • Fax:
Mailing address:
  • Phone: 707-448-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: