Healthcare Provider Details

I. General information

NPI: 1619646395
Provider Name (Legal Business Name): MARK DOWNEY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 CANYON CREST DR
RIVERSIDE CA
92507-7721
US

IV. Provider business mailing address

3004 MERIDIAN ST
BELLINGHAM WA
98225-1724
US

V. Phone/Fax

Practice location:
  • Phone: 747-224-2090
  • Fax:
Mailing address:
  • Phone: 818-934-1404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: