Healthcare Provider Details

I. General information

NPI: 1659761849
Provider Name (Legal Business Name): LOVE PSYCHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 GARNET AVE SUITE 102
SAN DIEGO CA
92109-3771
US

IV. Provider business mailing address

2204 GARNET AVE SUITE 102
SAN DIEGO CA
92109-3771
US

V. Phone/Fax

Practice location:
  • Phone: 619-559-8412
  • Fax: 619-821-8914
Mailing address:
  • Phone: 619-559-8412
  • Fax: 619-821-8914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberPSY18321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY18321
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY18321
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY18321
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY18321
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY18321
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY18321
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPSY18321
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY18321
License Number StateCA
# 10
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY18321
License Number StateCA

VIII. Authorized Official

Name: DR. YVONNE ROBLES LOVE
Title or Position: CLINICAL PSYCHOLOGIST/CEO
Credential: PSYD, MS
Phone: 559-250-5646