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NPI Code Detail

MEDICARE: PEDROSO PSYCHOLOGICAL SERVICES, LLC

MEDICARE: PEDROSO PSYCHOLOGICAL SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0850XAdult Mental Health Clinic/Center
2261QM0855XAdolescent and Children Mental Health Clinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235785395
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDROSO PSYCHOLOGICAL SERVICES, LLC
Provider Business Mailing Address
First Line : 11201 N TATUM BLVD STE 300
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-6039
Country : US
Telephone Number : 480-310-8090
Fax Number :
Provider Business Practice Location Address
First Line : 11201 N TATUM BLVD STE 300
Second Line :
City : PHOENIX
State : AZ
Zip : 85028-6039
Country : US
Telephone Number : 480-310-8090
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. DANIELLA PEDROSO
Credential : PSY.D.
Telephone Number : 480-310-8090
Provider Enumeration Date : 08/14/2019
Last Update Date : 02/05/2023

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Directions to “PEDROSO PSYCHOLOGICAL SERVICES, LLC ” Practice Location

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