Provider Demographics
NPI:1780440651
Name:BALDAL, CLAIRE KATHLEEN
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:KATHLEEN
Last Name:BALDAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 FAIRWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94089-2311
Mailing Address - Country:US
Mailing Address - Phone:408-523-4870
Mailing Address - Fax:
Practice Address - Street 1:1110 FAIRWOOD AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94089-2311
Practice Address - Country:US
Practice Address - Phone:408-523-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210155119103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool