MEDICARE: CORINNA YOUNG CASEY PH D PSYCHOLOGY

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	103TH0100X	Health Service Psychologist	PSY20004	CA
2	103T00000X	Psychologist	PSY20004	CA
3	103TC0700X	Clinical Psychologist	PSY20004	CA

General Provider Information

NPI Number	:	1750379400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORINNA YOUNG CASEY PH D PSYCHOLOGY

Provider Business Mailing Address
First Line	:	2262 CARMEL VALLEY RD
Second Line	:	SUITE E
City	:	DEL MAR
State	:	CA
Zip	:	92014-3751
Country	:	US
Telephone Number	:	858-794-9413
Fax Number	:	858-876-3128

Provider Business Practice Location Address
First Line	:	2262 CARMEL VALLEY RD
Second Line	:	SUITE E
City	:	DEL MAR
State	:	CA
Zip	:	92014-3751
Country	:	US
Telephone Number	:	858-794-9413
Fax Number	:	858-876-3128

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CORINNA YOUNG CASEY
Credential	:	PH.D.
Telephone Number	:	858-794-9413

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	08/16/2016

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