Basic Information
| Provider Information | |||||||||
| NPI: | 1306943303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116B PSYCHOLOGY SERVICE | ||||||||
| Address2: | 3350 LAJOLLA VILLAGE DRIVE | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921610001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586427563 | ||||||||
| FaxNumber: | 8585527414 | ||||||||
| Practice Location | |||||||||
| Address1: | 116B PSYCHOLOGY SERVICE | ||||||||
| Address2: | 3350 LAJOLLA VILLAGE DRIVE | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921610001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586427563 | ||||||||
| FaxNumber: | 8585527414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY 7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | 103TA0400X | PSY 7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TA0700X | PSY 7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | 103TB0200X | PSY 7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | PSY 7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | PSY 7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | PSY7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Family | 103TH0100X | PSY 7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Health Service | 103T00000X | PSY7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | 103TP2701X | PSY 7442 | CA | X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.