MEDICARE: DR. LYNNE CESSANTE 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	103TC0700X	Clinical Psychologist	PSY 19943	CA

General Provider Information

NPI Number	:	1386617793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNNE CESSANTE PH.D.

Provider Business Mailing Address
First Line	:	4390 TEMECULA ST
Second Line	:	#14
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-1148
Country	:	US
Telephone Number	:	619-517-4945
Fax Number	:	619-532-6070

Provider Business Practice Location Address
First Line	:	34730 BOB WILSON DR
Second Line	:	NAVAL MEDICAL CENTER NEUROSCIENCES DEPT DVBIC
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-3098
Country	:	US
Telephone Number	:	619-532-9936
Fax Number	:	619-532-6070

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/08/2007

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