Healthcare Provider Details

I. General information

NPI: 1245458132
Provider Name (Legal Business Name): KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 30TH ST STE 101
SAN DIEGO CA
92116-4286
US

IV. Provider business mailing address

6757 FRIARS RD UNIT 21
SAN DIEGO CA
92108-5013
US

V. Phone/Fax

Practice location:
  • Phone: 619-298-2098
  • Fax: 619-298-2098
Mailing address:
  • Phone: 619-298-0169
  • Fax: 619-298-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY21669
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39583
License Number StateCA

VIII. Authorized Official

Name: DR. KIMBERLY FARA CORBETT
Title or Position: PRESIDENT/CEO
Credential: PSY.D., M.F.T.
Phone: 619-298-0169