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General NPI Number Information
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NPI Number | 1609912302
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Entity Type | Individual
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Provider Name | LILIBETH GONZALES COSICO-BERGE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 327 S IVY ST
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City | ESCONDIDO
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State | CA
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Zip | 92025-4337
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Country | US
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Telephone | 858-220-5657
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Fax |
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Provider Business Mailing Address
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Address Line | 15715 CAMINITO GILBAR
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City | SAN DIEGO
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State | CA
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Zip | 92128-3356
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Country | US
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Telephone | 858-220-5657
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY19662
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License Number State | CA
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