Provider Demographics
NPI:1356881080
Name:JOHN FRAIRE ALDAVA IV, PHD, PSYCHOLOGY GROUP P.C.
Entity type:Organization
Organization Name:JOHN FRAIRE ALDAVA IV, PHD, PSYCHOLOGY GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-785-6682
Mailing Address - Street 1:1866 CLAYTON RD STE 103A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2566
Mailing Address - Country:US
Mailing Address - Phone:925-785-6682
Mailing Address - Fax:
Practice Address - Street 1:1866 CLAYTON RD STE 103A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2566
Practice Address - Country:US
Practice Address - Phone:925-785-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty