MEDICARE: DR. JULIA KUCK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PSY14060	CA
2	103TC0700X	Clinical Psychologist	PSY14060	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY14060	OTHER	CA	PSYCHOLOGY BOARD LICENSE

General Provider Information

NPI Number	:	1184611576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA KUCK PH.D.

Provider Business Mailing Address
First Line	:	4147 ADAMS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2509
Country	:	US
Telephone Number	:	619-281-1932
Fax Number	:	619-281-1947

Provider Business Practice Location Address
First Line	:	4147 ADAMS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2509
Country	:	US
Telephone Number	:	619-281-1932
Fax Number	:	619-281-1947

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	09/11/2025

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