MEDICARE: PSYCHOLOGY 360, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TB0200X	Cognitive & Behavioral Psychologist
2	103TF0200X	Forensic Psychologist
3	103TM1800X	Intellectual & Developmental Disabilities Psychologist
4	103TS0200X	School Psychologist
5	103T00000X	Psychologist
6	103TA0400X	Addiction (Substance Use Disorder) Psychologist
7	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1124975578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHOLOGY 360, INC.

Provider Business Mailing Address
First Line	:	6265 GREENWICH DR STE 230
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5921
Country	:	US
Telephone Number	:	858-877-0314
Fax Number	:

Provider Business Practice Location Address
First Line	:	6265 GREENWICH DR STE 230
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5921
Country	:	US
Telephone Number	:	858-877-0314
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/DIRECTOR
Name	:	DONICA DOHRENWEND
Credential	:	PHD
Telephone Number	:	858-877-0314

Provider Enumeration Date	:	03/13/2026
Last Update Date	:	03/13/2026

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