Healthcare Provider Details

I. General information

NPI: 1578936621
Provider Name (Legal Business Name): SOCIAL GOOD FUND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2015
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 COMSTOCK ST
SAN DIEGO CA
92111-6502
US

IV. Provider business mailing address

3525 DEL MAR HEIGHTS RD SUITE 302
SAN DIEGO CA
92130-2199
US

V. Phone/Fax

Practice location:
  • Phone: 844-422-7327
  • Fax: 844-422-7327
Mailing address:
  • Phone: 844-422-7327
  • Fax: 844-422-7327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY11764
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPSY11764
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPSY11764
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPSY11764
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY11764
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY11764
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY11764
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY11764
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY11764
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY11764
License Number StateCA
# 11
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPSY11764
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICIA JONES
Title or Position: POSTDOCTORAL FELLOW
Credential: PSY.D.
Phone: 858-531-6959