Provider Demographics
NPI:1346385044
Name:MITTELSTADT, PATRICIA ANN (PHD ABPDN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:MITTELSTADT
Suffix:
Gender:F
Credentials:PHD ABPDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:851 FREMONT AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5602
Mailing Address - Country:US
Mailing Address - Phone:650-949-1236
Mailing Address - Fax:650-949-1302
Practice Address - Street 1:851 FREMONT AVE STE 105
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5602
Practice Address - Country:US
Practice Address - Phone:650-949-1236
Practice Address - Fax:650-949-1302
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12703103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist