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General NPI Number Information
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NPI Number | 1790329613
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Entity Type | Organization
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Legal Business Name | GROWGOOD PSYCHOLOGY, CORP
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Dates
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Enumeration Date | 11/04/2019
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 5920 FRIARS RD STE 208
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City | SAN DIEGO
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State | CA
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Zip | 92108-1078
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Country | US
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Telephone | 858-480-6452
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Fax | 619-793-1492
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Provider Business Mailing Address
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Address Line | 5920 FRIARS RD STE 208
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City | SAN DIEGO
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State | CA
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Zip | 92108-1078
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Country | US
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Telephone | 858-480-6452
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Fax | 619-793-1492
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAEGAN D CASANOVA
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Credential | PSYD
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Telephone | 760-505-2985
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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 |
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License Number State |
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