Healthcare Provider Details

I. General information

NPI: 1265756597
Provider Name (Legal Business Name): KELLY BAIER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2010
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11858 BERNARDO PLAZA CT STE 210
SAN DIEGO CA
92128-2411
US

IV. Provider business mailing address

11858 BERNARDO PLAZA CT STE 210
SAN DIEGO CA
92128-2411
US

V. Phone/Fax

Practice location:
  • Phone: 858-236-9087
  • Fax:
Mailing address:
  • Phone: 858-236-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY22425
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22425
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY22425
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberPSY22425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: