Provider Demographics
NPI:1699834507
Name:PEDERSEN, ERIK TODD (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:TODD
Last Name:PEDERSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 370
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1106
Mailing Address - Country:US
Mailing Address - Phone:408-363-4864
Mailing Address - Fax:408-972-3353
Practice Address - Street 1:275 TENNANT AVE STE 202
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5476
Practice Address - Country:US
Practice Address - Phone:408-831-6687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20526103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical