Healthcare Provider Details

I. General information

NPI: 1255668455
Provider Name (Legal Business Name): SHERRY G CASPER PSY D /PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9606 TIERRA GRANDE #201 SUITE 107
SAN DIEGO CA
92126
US

IV. Provider business mailing address

PO BOX 421146
SAN DIEGO CA
92142
US

V. Phone/Fax

Practice location:
  • Phone: 619-485-5961
  • Fax: 877-485-5961
Mailing address:
  • Phone: 619-807-7410
  • Fax: 877-485-5961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberPSY20550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: