Provider Demographics
NPI:1063574242
Name:CAIN, DAVID J (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:CAIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 WARING CT
Mailing Address - Street 2:SUITE H
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4509
Mailing Address - Country:US
Mailing Address - Phone:760-726-6464
Mailing Address - Fax:760-726-6483
Practice Address - Street 1:3230 WARING CT
Practice Address - Street 2:SUITE H
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-726-6464
Practice Address - Fax:760-726-6483
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY066540Medicaid
CAPSY066540Medicaid