Provider Demographics
NPI:1932246998
Name:ADDICOTT, ADRIENNE K (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:K
Last Name:ADDICOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ADRIENNE
Other - Middle Name:KATHLEEN
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2001 JUNIPERO SERRA BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3897
Mailing Address - Country:US
Mailing Address - Phone:650-991-6138
Mailing Address - Fax:
Practice Address - Street 1:2001 JUNIPERO SERRA BLVD STE 650
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-3897
Practice Address - Country:US
Practice Address - Phone:650-991-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21084103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist