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General NPI Number Information
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NPI Number | 1598476640
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Entity Type | Individual
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Provider Name | ALYSSA CHIMIKLIS
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Gender | Female
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Dates
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Enumeration Date | 12/09/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 2659 STATE ST STE 100
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City | CARLSBAD
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State | CA
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Zip | 92008-1627
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Country | US
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Telephone | 781-718-0002
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 PASEO VILLAGE WAY APT 1815
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City | SAN DIEGO
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State | CA
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Zip | 92130-3252
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Country | US
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Telephone | 781-718-0002
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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 | 024083
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License Number State | NY
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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 | PSY32438
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License Number State | CA
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