MEDICARE: VALERIE JAY PEARSON PH.D.

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PSY14889	CA
2	103TB0200X	Cognitive & Behavioral Psychologist	PSY14889	CA
3	103TC0700X	Clinical Psychologist	PSY14889	CA
4	103TP2701X	Group Psychotherapy Psychologist	PSY14889	CA
5	103TR0400X	Rehabilitation Psychologist	PSY14889	CA
6	103T00000X	Psychologist	PSY14889	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5883430	OTHER	CA	MEDI CAL IDENTIFIER

General Provider Information

NPI Number	:	1366437691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE JAY PEARSON PH.D.

Provider Business Mailing Address
First Line	:	426 PENNSYLVANIA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4206
Country	:	US
Telephone Number	:	619-804-8044
Fax Number	:	760-489-8700

Provider Business Practice Location Address
First Line	:	426 PENNSYLVANIA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-4206
Country	:	US
Telephone Number	:	619-804-8044
Fax Number	:	760-489-8700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	02/24/2016

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