Provider Demographics
NPI:1831182492
Name:DRYDYK, STEVEN JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:DRYDYK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 EAST WARNER ROAD
Mailing Address - Street 2:SUITE 101-H
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296
Mailing Address - Country:US
Mailing Address - Phone:480-339-7155
Mailing Address - Fax:480-339-7156
Practice Address - Street 1:1166 EAST WARNER ROAD
Practice Address - Street 2:SUITE 101-H
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296
Practice Address - Country:US
Practice Address - Phone:480-339-7155
Practice Address - Fax:480-339-7156
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1149103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0616120OtherBLUECROSS BLUESHIELD PIN
AZR19314Medicare UPIN
AZZ7759Medicare PIN