Provider Demographics
NPI:1336687797
Name:PAFENBERG, TROY
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:PAFENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:TROY
Other - Middle Name:E
Other - Last Name:PAFENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4990 SPEAK LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2776
Mailing Address - Country:US
Mailing Address - Phone:408-826-9650
Mailing Address - Fax:408-267-9649
Practice Address - Street 1:4990 SPEAK LN STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2776
Practice Address - Country:US
Practice Address - Phone:408-826-9650
Practice Address - Fax:408-267-9649
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW711921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical