Basic Information
| Provider Information | |||||||||
| NPI: | 1881888725 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCHOLOGICAL & FAMILY SUPPORT SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1704 GUAVA LN | ||||||||
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| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920208328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195890552 | ||||||||
| FaxNumber: | 6195890205 | ||||||||
| Practice Location | |||||||||
| Address1: | 5400 CONNECTICUT AVE | ||||||||
| Address2: | SUITE E | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919421213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195890552 | ||||||||
| FaxNumber: | 8003341041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2007 | ||||||||
| LastUpdateDate: | 08/28/2012 | ||||||||
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| AuthorizedOfficialLastName: | PAPALEO | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6195890552 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PSY7515 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.