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General NPI Number Information
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NPI Number | 1306216619
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Entity Type | Individual
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Provider Name | UTA MAEDA PHD
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 932 SANTA CRUZ AVE STE A
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City | MENLO PARK
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State | CA
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Zip | 94025-4633
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Country | US
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Telephone | 650-521-9949
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2233
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City | REDWOOD CITY
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State | CA
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Zip | 94064-2233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 27654
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License Number State | CA
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