Provider Demographics
NPI:1316815038
Name:SAN JOSE THERAPY, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity type:Organization
Organization Name:SAN JOSE THERAPY, A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAFENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-418-5560
Mailing Address - Street 1:4990 SPEAK LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-2776
Mailing Address - Country:US
Mailing Address - Phone:408-418-5560
Mailing Address - Fax:669-235-4442
Practice Address - Street 1:4990 SPEAK LN STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-2776
Practice Address - Country:US
Practice Address - Phone:408-418-5560
Practice Address - Fax:669-235-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty