Provider Demographics
NPI:1851410807
Name:HESTERLY, PATRICIA GREGG (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:GREGG
Last Name:HESTERLY
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:PO BOX 94380
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-4380
Mailing Address - Country:US
Mailing Address - Phone:626-660-8568
Mailing Address - Fax:626-628-1803
Practice Address - Street 1:595 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2039
Practice Address - Country:US
Practice Address - Phone:626-660-8568
Practice Address - Fax:626-628-1803
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical