Healthcare Provider Details

I. General information

NPI: 1265633689
Provider Name (Legal Business Name): APPLIED INTERVENTIONS & METHODOLOGIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6540 LUSK BLVD STE C256
SAN DIEGO CA
92121-5795
US

IV. Provider business mailing address

6540 LUSK BLVD STE C256
SAN DIEGO CA
92121-5795
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-9117
  • Fax:
Mailing address:
  • Phone: 858-657-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberPSY18351
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberPSY18351
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY18351
License Number StateCA

VIII. Authorized Official

Name: DR. SANDY SHAW
Title or Position: CLINICAL PSYCHOLOGIST, DIRECTOR
Credential: PH.D.
Phone: 858-492-8511