Healthcare Provider Details

I. General information

NPI: 1649387259
Provider Name (Legal Business Name): NORTH CITY PSYCHOLOGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9683 TIERRA GRANDE ST STE 105
SAN DIEGO CA
92126-6503
US

IV. Provider business mailing address

9683 TIERRA GRANDE ST STE 105
SAN DIEGO CA
92126-6503
US

V. Phone/Fax

Practice location:
  • Phone: 858-695-2237
  • Fax:
Mailing address:
  • Phone: 858-695-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROGER BRIAN STORRS
Title or Position: DIRECTOR
Credential: PH D
Phone: 858-695-2237