Healthcare Provider Details

I. General information

NPI: 1750379400
Provider Name (Legal Business Name): CORINNA YOUNG CASEY PH D PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 CARMEL VALLEY RD SUITE E
DEL MAR CA
92014-3751
US

IV. Provider business mailing address

2262 CARMEL VALLEY RD SUITE E
DEL MAR CA
92014-3751
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-9413
  • Fax: 858-876-3128
Mailing address:
  • Phone: 858-794-9413
  • Fax: 858-876-3128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY20004
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20004
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY20004
License Number StateCA

VIII. Authorized Official

Name: DR. CORINNA YOUNG CASEY
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 858-794-9413