Provider Demographics
NPI:1558563288
Name:PANAGAKIS, PANAGIOTIS PETER (PSYD)
Entity type:Individual
Prefix:
First Name:PANAGIOTIS
Middle Name:PETER
Last Name:PANAGAKIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:PANAGAKIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7900
Mailing Address - Fax:
Practice Address - Street 1:4220 APEX HWY STE 200
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5295
Practice Address - Country:US
Practice Address - Phone:855-501-1004
Practice Address - Fax:866-822-7012
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5188103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist