Provider Demographics
NPI:1649319807
Name:PAPADAKOS, ATHENA P (PHD)
Entity type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:P
Last Name:PAPADAKOS
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 1:870 MARKET ST STE 1055
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-2928
Mailing Address - Country:US
Mailing Address - Phone:415-602-4198
Mailing Address - Fax:415-621-5803
Practice Address - Street 1:870 MARKET ST STE 1055
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-2928
Practice Address - Country:US
Practice Address - Phone:415-602-4198
Practice Address - Fax:415-621-5803
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19047103TC0700X
NY13037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL190470Medicare ID - Type UnspecifiedMEDICARE PROV NO. CA
NYV92821Medicare ID - Type UnspecifiedMEDICARE PROV NO. NY