Provider Demographics
NPI:1063053726
Name:DR. NASTASSIA REBECCA RISER, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:DR. NASTASSIA REBECCA RISER, A PROFESSIONAL PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA (NASTASSIA)
Authorized Official - Middle Name:E
Authorized Official - Last Name:RISER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PHD
Authorized Official - Phone:760-492-9057
Mailing Address - Street 1:700 GARDEN VIEW CT STE 201J
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2479
Mailing Address - Country:US
Mailing Address - Phone:760-492-9057
Mailing Address - Fax:
Practice Address - Street 1:700 GARDEN VIEW CT STE 201J
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2479
Practice Address - Country:US
Practice Address - Phone:760-492-9057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health