MEDICARE: SOLACE PSYCHOLOGY INC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1457115362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLACE PSYCHOLOGY INC

Provider Business Mailing Address
First Line	:	864 GRAND AVE STE 130
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3906
Country	:	US
Telephone Number	:	858-504-7743
Fax Number	:	858-216-1928

Provider Business Practice Location Address
First Line	:	8355 STATION VILLAGE LN UNIT 4116
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-6573
Country	:	US
Telephone Number	:	858-504-7743
Fax Number	:	858-216-1928

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LINA KOGAN-SBARBARO
Credential	:	PSYD
Telephone Number	:	858-504-7743

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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Directions to “SOLACE PSYCHOLOGY INC ” Practice Location

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