Healthcare Provider Details

I. General information

NPI: 1073755401
Provider Name (Legal Business Name): CONCEPT HEALTHCARE PSYCHOLOGY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W STETSON AVE
HEMET CA
92545-6882
US

IV. Provider business mailing address

4901 MORENA BLVD SUITE 109
SAN DIEGO CA
92117-3423
US

V. Phone/Fax

Practice location:
  • Phone: 951-925-9171
  • Fax: 951-925-8186
Mailing address:
  • Phone: 858-272-3992
  • Fax: 858-272-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY5291
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH M CASCIANI
Title or Position: PRESIDENT
Credential: PHD
Phone: 858-272-3992