Provider Demographics
NPI:1225053242
Name:PAZDERNIK, JOSEPH M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:PAZDERNIK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 E CAMPBELL AVE
Mailing Address - Street 2:# 11-C
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2139
Mailing Address - Country:US
Mailing Address - Phone:408-374-4665
Mailing Address - Fax:408-374-4665
Practice Address - Street 1:621 E CAMPBELL AVE
Practice Address - Street 2:# 11-C
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2139
Practice Address - Country:US
Practice Address - Phone:408-374-4665
Practice Address - Fax:408-374-4665
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12129103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist