Healthcare Provider Details

I. General information

NPI: 1487119749
Provider Name (Legal Business Name): CIRCADIAN PSYCHOLOGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 4TH AVE
SAN DIEGO CA
92103-4203
US

IV. Provider business mailing address

3702 4TH AVE
SAN DIEGO CA
92103-4203
US

V. Phone/Fax

Practice location:
  • Phone: 760-607-7257
  • Fax: 877-912-4883
Mailing address:
  • Phone: 760-607-7257
  • Fax: 877-912-4883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ASHLEY CARAVELLA
Title or Position: OWNER
Credential: MFT
Phone: 760-607-7257