MEDICARE: HILLCREST PSYCHOLOGICAL SERVICES, INC.

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	PSY13981	CA

General Provider Information

NPI Number	:	1629110127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST PSYCHOLOGICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	3233 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5615
Country	:	US
Telephone Number	:	619-298-6610
Fax Number	:

Provider Business Practice Location Address
First Line	:	3233 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5615
Country	:	US
Telephone Number	:	619-298-6610
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. SHARI MEDNITSKY
Credential	:
Telephone Number	:	619-298-6610

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	09/26/2018

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