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General NPI Number Information
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NPI Number | 1689949463
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Entity Type | Organization
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Legal Business Name | JEFF SCHANOWITZ, PH.D.
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 2831 CAMINO DEL RIO S 213
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City | SAN DIEGO
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State | CA
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Zip | 92108-3802
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Country | US
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Telephone | 619-252-3713
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Fax | 619-297-6600
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Provider Business Mailing Address
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Address Line | 2673 MATERA LN
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City | SAN DIEGO
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State | CA
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Zip | 92108-6737
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Country | US
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Telephone | 619-252-3713
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Fax | 619-297-6600
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFF SCHANOWITZ
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Credential | PH.D.
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Telephone | 619-252-3713
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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 | PSY20362
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License Number State | CA
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