Provider Demographics
NPI:1568413250
Name:DEARDORFF, WILLIAM WADE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WADE
Last Name:DEARDORFF
Suffix:
Gender:M
Credentials:PHD
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Mailing Address - Street 1:PO BOX 9061
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372-9061
Mailing Address - Country:US
Mailing Address - Phone:714-437-7400
Mailing Address - Fax:714-437-7410
Practice Address - Street 1:120 S SPALDING DR
Practice Address - Street 2:SUITE 400
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1800
Practice Address - Country:US
Practice Address - Phone:714-437-7400
Practice Address - Fax:714-437-7410
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY9740103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY9740OtherSTATE LICENSE