Provider Demographics
NPI:1932584539
Name:CHITWOOD, PAUL K (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:K
Last Name:CHITWOOD
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 1:4811 CHIPPENDALE DR
Mailing Address - Street 2:# 302
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-2555
Mailing Address - Country:US
Mailing Address - Phone:916-349-9403
Mailing Address - Fax:
Practice Address - Street 1:4811 CHIPPENDALE DR
Practice Address - Street 2:# 302
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-2555
Practice Address - Country:US
Practice Address - Phone:916-349-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14963103TA0400X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY14963OtherSTATE OF CALIFORNIA