MEDICARE: NORTH CITY PSYCHOLOGICAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TC0700X	Clinical Psychologist
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1649387259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CITY PSYCHOLOGICAL GROUP

Provider Business Mailing Address
First Line	:	9683 TIERRA GRANDE ST STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-6503
Country	:	US
Telephone Number	:	858-695-2237
Fax Number	:

Provider Business Practice Location Address
First Line	:	9683 TIERRA GRANDE ST STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-6503
Country	:	US
Telephone Number	:	858-695-2237
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ROGER BRIAN STORRS
Credential	:	PH D
Telephone Number	:	858-695-2237

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/17/2010

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