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General NPI Number Information
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NPI Number | 1265756597
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Entity Type | Individual
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Provider Name | KELLY BAIER PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2010
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 11858 BERNARDO PLAZA CT STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92128-2411
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Country | US
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Telephone | 858-236-9087
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Fax |
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Provider Business Mailing Address
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Address Line | 11858 BERNARDO PLAZA CT STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92128-2411
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Country | US
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Telephone | 858-236-9087
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Fax |
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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 | PSY22425
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY22425
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | PSY22425
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY22425
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License Number State | CA
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