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General NPI Number Information
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NPI Number | 1710305818
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Entity Type | Organization
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Legal Business Name | DEBORAH COSMETIS, PSY.D., PSYCHOLOGIST INC.
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 3990 OLD TOWN AVE STE A208
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City | SAN DIEGO
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State | CA
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Zip | 92110-2967
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Country | US
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Telephone | 619-786-0674
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Fax |
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Provider Business Mailing Address
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Address Line | 3990 OLD TOWN AVE STE A208
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City | SAN DIEGO
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State | CA
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Zip | 92110-2967
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Country | US
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Telephone | 619-786-0674
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DEBORAH COSMETIS
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Credential | PSY.D.
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Telephone | 619-786-0674
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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 | PSY24117
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License Number State | CA
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