MEDICARE: COHEALTH PSYCHOLOGY SERVICES, PA

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	1041C0700X	Clinical Social Worker
2	103TH0004X	Health Psychologist

General Provider Information

NPI Number	:	1326200981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COHEALTH PSYCHOLOGY SERVICES, PA

Provider Business Mailing Address
First Line	:	4901 MORENA BLVD
Second Line	:	SUITE 109
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3423
Country	:	US
Telephone Number	:	858-272-3992
Fax Number	:	858-272-3804

Provider Business Practice Location Address
First Line	:	4901 MORENA BLVD
Second Line	:	SUITE 109
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3423
Country	:	US
Telephone Number	:	858-272-3992
Fax Number	:	858-272-3804

Authorized Official
Title or Position	:	CEO
Name	:	MR. JOSEPH M. CASCIANI
Credential	:	PHD
Telephone Number	:	858-272-3992

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	09/19/2008

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