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General NPI Number Information
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NPI Number | 1851756001
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Entity Type | Organization
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Legal Business Name | SJC BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 2333 CAMINO DE RIO S 160
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City | SAN DIEGO
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State | CA
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Zip | 92108
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Country | US
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Telephone | 619-342-4155
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Fax |
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Provider Business Mailing Address
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Address Line | 2333 CAMINO DEL RIO S STE 160
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City | SAN DIEGO
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State | CA
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Zip | 92108-3617
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Country | US
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Telephone | 619-342-4155
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Fax |
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Authorized Official
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Title or Position | OWNER / CLINICAL PSYCHOLOGIST
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Name | DR. STEVEN COVELLUZZI
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Credential | PSY.D.
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Telephone | 619-342-4155
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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 | PSY 24668
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License Number State | CA
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