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General NPI Number Information
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NPI Number | 1629306907
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Entity Type | Individual
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Provider Name | JERRY ALBERT KASDORF PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 24511 W JAYNE AVE 5002
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City | COALINGA
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State | CA
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Zip | 93210-9503
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Country | US
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Telephone | 559-935-7311
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Fax | 559-935-7271
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Provider Business Mailing Address
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Address Line | 24511 WEST JAYNE AVENUE P O BOX 5002
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City | COALINGA
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State | CA
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Zip | 93210-5002
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Country | US
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Telephone | 559-935-7311
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Fax | 559-935-7271
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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 | PSY 4865
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License Number State | CA
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