Healthcare Provider Details

I. General information

NPI: 1093078164
Provider Name (Legal Business Name): JOANNA SAVARESE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S HIGHWAY 101 STE 1E
SOLANA BEACH CA
92075-2628
US

IV. Provider business mailing address

731 S HIGHWAY 101 STE 1E
SOLANA BEACH CA
92075-2628
US

V. Phone/Fax

Practice location:
  • Phone: 858-752-4396
  • Fax:
Mailing address:
  • Phone: 858-752-4396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number24973
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number24973
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24973
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number24973
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number24973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: