Healthcare Provider Details

I. General information

NPI: 1194949370
Provider Name (Legal Business Name): CATHERINE FITZSIMONS JERVEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 KENYON ST
SAN DIEGO CA
92110-5001
US

IV. Provider business mailing address

5141 RANDLETT DR
LA MESA CA
91941-3900
US

V. Phone/Fax

Practice location:
  • Phone: 619-221-6550
  • Fax:
Mailing address:
  • Phone: 619-698-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY7427
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: