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General NPI Number Information
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NPI Number | 1558719492
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Entity Type | Organization
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Legal Business Name | SAGE PSYCHOLOGICAL SERVICES, PC
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Dates
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Enumeration Date | 06/01/2016
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Last Update Date | 06/01/2016
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Provider Practice Location Address
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Address Line | 2835 CAMINO DEL RIO S SUITE 120
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City | SAN DIEGO
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State | CA
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Zip | 92108-3825
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Country | US
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Telephone | 858-228-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 CAMINO DEL RIO S SUITE 120
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City | SAN DIEGO
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State | CA
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Zip | 92108-3825
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Country | US
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Telephone | 858-228-7701
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAGE SCHUITEVOERDER
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Credential | PH.D.
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Telephone | 858-228-7701
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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 | 25395
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License Number State | CA
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