Provider Demographics
NPI:1770828840
Name:DEWEY, PAUL EDWARD
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:DEWEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11321 CAMARILLO ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-1216
Mailing Address - Country:US
Mailing Address - Phone:818-506-4455
Mailing Address - Fax:
Practice Address - Street 1:11321 CAMARILLO ST
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1216
Practice Address - Country:US
Practice Address - Phone:818-506-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)