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General NPI Number Information
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NPI Number | 1114696705
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Entity Type | Organization
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Legal Business Name | CENTRAL COAST NEUROPSYCHOLOGY, INC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 2774 JEFFERSON ST
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City | CARLSBAD
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State | CA
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Zip | 92008-1769
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Country | US
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Telephone | 833-926-3876
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Fax | 833-997-0837
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Provider Business Mailing Address
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Address Line | 1549 N VULCAN AVE SPC 1
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City | ENCINITAS
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State | CA
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Zip | 92024-1547
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Country | US
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Telephone | 833-926-3876
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Fax | 833-997-0837
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Authorized Official
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Title or Position | SECRETARY
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Name | DR. CATHERINE JUNE WARD
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Credential | PSYD
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Telephone | 833-926-3876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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