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General NPI Number Information
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NPI Number | 1548881501
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Entity Type | Organization
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Legal Business Name | SAN DIEGO PSYCHOLOGICAL COUPLE CARE, INC.
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Dates
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Enumeration Date | 04/30/2020
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Last Update Date | 04/30/2020
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Provider Practice Location Address
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Address Line | 3233 3RD AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-5615
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Country | US
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Telephone | 619-784-8504
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Fax | 619-790-4776
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Provider Business Mailing Address
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Address Line | 3233 3RD AVE
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City | SAN DIEGO
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State | CA
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Zip | 92103-5615
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Country | US
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Telephone | 619-784-8504
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Fax | 619-790-4776
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Authorized Official
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Title or Position | CEO
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Name | DR. LARISA CICILA
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Credential | PHD
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Telephone | 619-784-8504
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State |
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