Healthcare Provider Details

I. General information

NPI: 1871370320
Provider Name (Legal Business Name): ANDREA M KULBERG, PHD CLINICAL PSYCHOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 E VALLEY RD STE 17
MONTECITO CA
93108-1200
US

IV. Provider business mailing address

1187 COAST VILLAGE RD STE 375
SANTA BARBARA CA
93108-2737
US

V. Phone/Fax

Practice location:
  • Phone: 805-705-0614
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHANNON KNOX
Title or Position: BILLING MANAGER
Credential:
Phone: 805-729-0180