MEDICARE: KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC39583	CA
2	103TC0700X	Clinical Psychologist	PSY21669	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	352923	OTHER	CA	CIGNA
2	7314642	OTHER	CA	AETNA
3	MFC395830	OTHER	CA	BLUE SHIELD AND TRICARE

General Provider Information

NPI Number	:	1245458132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP.

Provider Business Mailing Address
First Line	:	6757 FRIARS RD UNIT 21
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5013
Country	:	US
Telephone Number	:	619-298-0169
Fax Number	:	619-298-0169

Provider Business Practice Location Address
First Line	:	4411 30TH ST STE 101
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4286
Country	:	US
Telephone Number	:	619-298-2098
Fax Number	:	619-298-2098

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. KIMBERLY FARA CORBETT
Credential	:	PSY.D., M.F.T.
Telephone Number	:	619-298-0169

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	09/15/2007

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Directions to “KIMBERLY CORBETT, PSY.D., A PSYCHOLOGICAL CORP. ” Practice Location

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