Healthcare Provider Details

I. General information

NPI: 1326200981
Provider Name (Legal Business Name): COHEALTH PSYCHOLOGY SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 MORENA BLVD SUITE 109
SAN DIEGO CA
92117-3423
US

IV. Provider business mailing address

4901 MORENA BLVD SUITE 109
SAN DIEGO CA
92117-3423
US

V. Phone/Fax

Practice location:
  • Phone: 858-272-3992
  • Fax: 858-272-3804
Mailing address:
  • Phone: 858-272-3992
  • Fax: 858-272-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH M. CASCIANI
Title or Position: CEO
Credential: PHD
Phone: 858-272-3992