Provider Demographics
NPI:1841543964
Name:ADRIENNE E. PASEK, PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:ADRIENNE E. PASEK, PROFESSIONAL PSYCHOLOGICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PASEK
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:949-201-5779
Mailing Address - Street 1:1151 DOVE ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2840
Mailing Address - Country:US
Mailing Address - Phone:949-201-5779
Mailing Address - Fax:877-209-7251
Practice Address - Street 1:1151 DOVE ST
Practice Address - Street 2:SUITE 115
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2840
Practice Address - Country:US
Practice Address - Phone:949-201-5779
Practice Address - Fax:877-209-7251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty