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General NPI Number Information
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NPI Number | 1154692002
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Entity Type | Individual
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Provider Name | STEPHANIE BYRD PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/24/2012
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Last Update Date | 03/26/2017
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Provider Practice Location Address
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Address Line | 500 W HARBOR DR 305
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City | SAN DIEGO
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State | CA
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Zip | 92101-7715
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Country | US
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Telephone | 727-674-3593
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Fax | 619-858-2383
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Provider Business Mailing Address
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Address Line | 1350 COLUMBIA ST 800
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City | SAN DIEGO
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State | CA
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Zip | 92101-3454
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Country | US
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Telephone | 727-674-3593
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Fax | 619-858-2383
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY24265
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License Number State | CA
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