Healthcare Provider Details

I. General information

NPI: 1326174913
Provider Name (Legal Business Name): ROGER J CAREY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5222 PIRRONE CT STE 101A
SALIDA CA
95368-9072
US

IV. Provider business mailing address

5222 PIRRONE CT STE 101A
SALIDA CA
95368-9072
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 925-282-1778
  • Fax: 415-296-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: