Healthcare Provider Details

I. General information

NPI: 1285226548
Provider Name (Legal Business Name): JEANNETTE GOLDSBERRY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8880 RIO SAN DIEGO DR STE 800
SAN DIEGO CA
92108-1642
US

IV. Provider business mailing address

3911 CLEVELAND AVE # 635195
SAN DIEGO CA
92103-3402
US

V. Phone/Fax

Practice location:
  • Phone: 619-738-5458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number30917
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: