Provider Demographics
NPI:1437289519
Name:DENICOLA, JOSEPH A (PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:DENICOLA
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 1:812 POLLARD RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-1420
Mailing Address - Country:US
Mailing Address - Phone:408-370-7333
Mailing Address - Fax:
Practice Address - Street 1:812 POLLARD RD STE 6
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1420
Practice Address - Country:US
Practice Address - Phone:408-370-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7190103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical