Provider Demographics
NPI:1073847752
Name:MADDOX, RICHARD JOSHUA (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOSHUA
Last Name:MADDOX
Suffix:
Gender:M
Credentials:MA, PHD
Other - Prefix:DR
Other - First Name:JOSH
Other - Middle Name:
Other - Last Name:MADDOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, PHD
Mailing Address - Street 1:409 ALBERTO WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5407
Mailing Address - Country:US
Mailing Address - Phone:408-357-4102
Mailing Address - Fax:408-550-1879
Practice Address - Street 1:409 ALBERTO WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5407
Practice Address - Country:US
Practice Address - Phone:408-357-4102
Practice Address - Fax:408-550-1879
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical