Provider Demographics
NPI:1033463153
Name:PALAFOX, GWENNYTH L (PHD)
Entity Type:Individual
Prefix:MRS
First Name:GWENNYTH
Middle Name:L
Last Name:PALAFOX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 S MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4207
Mailing Address - Country:US
Mailing Address - Phone:626-795-4092
Mailing Address - Fax:626-795-9505
Practice Address - Street 1:1001 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4207
Practice Address - Country:US
Practice Address - Phone:626-795-4092
Practice Address - Fax:626-795-9505
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20494103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical