Healthcare Provider Details

I. General information

NPI: 1376320259
Provider Name (Legal Business Name): GLENMAR PSYCHOLOGICAL SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 S RANCHO SANTA FE RD STE F50
ENCINITAS CA
92024-6334
US

IV. Provider business mailing address

162 S RANCHO SANTA FE RD STE F50
ENCINITAS CA
92024-6334
US

V. Phone/Fax

Practice location:
  • Phone: 415-497-3369
  • Fax:
Mailing address:
  • Phone: 415-497-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: GLENN MOTOLA
Title or Position: CEO
Credential:
Phone: 415-497-3369