=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255682167
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLCARE BEHAVIORAL HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2012
-----------------------------------------------------
Last Update Date | 10/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3790 VIA DA LA VALLE SUITE 108E
-----------------------------------------------------
City | DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-487-1428
-----------------------------------------------------
Fax | 818-881-2863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3790 VIA DA LA VALLE SUITE 108E
-----------------------------------------------------
City | DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-487-1428
-----------------------------------------------------
Fax | 818-881-2863
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. LINDSEY GOLDSTEIN-FOWLER
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 760-487-1428
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | PSY25082
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------