MEDICARE: PSYCARE,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	106H00000X	Marriage & Family Therapist		CA

General Provider Information

NPI Number	:	1811977606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCARE,INC.

Provider Business Mailing Address
First Line	:	4550 KEARNY VILLA RD
Second Line	:	STE 116
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1578
Country	:	US
Telephone Number	:	858-279-1223
Fax Number	:	619-516-4757

Provider Business Practice Location Address
First Line	:	4550 KEARNY VILLA RD
Second Line	:	STE 116
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1578
Country	:	US
Telephone Number	:	858-279-1223
Fax Number	:	619-516-4757

Authorized Official
Title or Position	:	PRESIDENT/ C.E.O
Name	:	MR. ROBERT ALAN FRIEDMAN
Credential	:	M.D.
Telephone Number	:	858-279-1223

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	08/22/2020

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