Provider Demographics
NPI:1699007591
Name:PASEK, ADRIENNE ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:ELIZABETH
Last Name:PASEK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8941 ATLANTA AVE
Mailing Address - Street 2:STE 319
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7121
Mailing Address - Country:US
Mailing Address - Phone:949-201-5779
Mailing Address - Fax:877-209-7251
Practice Address - Street 1:8941 ATLANTA AVE
Practice Address - Street 2:STE 319
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7121
Practice Address - Country:US
Practice Address - Phone:949-201-5779
Practice Address - Fax:877-209-7251
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23321103TB0200X, 103TC0700X, 103TC2200X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAD OPL233211OtherBLUE SHIELD