Provider Demographics
NPI:1245340496
Name:POOLE, JOHN H (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:POOLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3801 MIRANDA AVE # 117
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1207
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-849-0526
Practice Address - Street 1:3801 MIRANDA AVE # 117
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-849-0526
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16133103G00000X, 103T00000X, 103TR0400X, 1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No1744R1102XOther Service ProvidersSpecialistResearch Study