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General NPI Number Information
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NPI Number | 1720899339
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Entity Type | Individual
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Provider Name | KRISTEN MAURA MCCABE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/15/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 888 PROSPECT ST
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City | LA JOLLA
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State | CA
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Zip | 92037-4260
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Country | US
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Telephone | 619-804-0609
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Fax |
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Provider Business Mailing Address
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Address Line | 5912 BELLEVUE AVE
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City | LA JOLLA
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State | CA
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Zip | 92037-7314
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Country | US
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Telephone | 619-804-0609
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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 | PSY15826
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY15826
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License Number State | CA
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