Provider Demographics
NPI:1801404389
Name:LANDAU, PAIGE (PHD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:LANDAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7662 E COSTILLA AVE
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1207
Mailing Address - Country:US
Mailing Address - Phone:484-336-5049
Mailing Address - Fax:
Practice Address - Street 1:2170 S PARKER RD STE 290
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5748
Practice Address - Country:US
Practice Address - Phone:484-336-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2023-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
CO0006019103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent