MEDICARE: ANNE-MARISA STINSON PSYD

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	PSY 23587	CA

General Provider Information

NPI Number	:	1467637876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE-MARISA STINSON PSYD

Provider Business Mailing Address
First Line	:	990 HIGHLAND DR
Second Line	:	SUITE 207
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-2408
Country	:	US
Telephone Number	:	760-672-0822
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 HIGHLAND DR
Second Line	:	SUITE 207
City	:	SOLANA BEACH
State	:	CA
Zip	:	92075-2408
Country	:	US
Telephone Number	:	760-672-0822
Fax Number	:

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

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	12/14/2010

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