Provider Demographics
NPI:1003336868
Name:KIRITSIS, PAUL (PSYD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:KIRITSIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DEERWOOD ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4409
Mailing Address - Country:US
Mailing Address - Phone:925-270-4499
Mailing Address - Fax:925-270-4499
Practice Address - Street 1:111 DEERWOOD ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4409
Practice Address - Country:US
Practice Address - Phone:925-270-4499
Practice Address - Fax:925-270-4499
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY32702103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program