Provider Demographics
NPI:1386037208
Name:SILICON VALLEY PSYCHOLOGY
Entity Type:Organization
Organization Name:SILICON VALLEY PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:POLIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:408-772-5378
Mailing Address - Street 1:901 CAMPISI WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2339
Mailing Address - Country:US
Mailing Address - Phone:408-772-5378
Mailing Address - Fax:669-222-8368
Practice Address - Street 1:901 CAMPISI WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2339
Practice Address - Country:US
Practice Address - Phone:408-772-5378
Practice Address - Fax:669-222-8368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABJ356AMedicare PIN