Provider Demographics
NPI:1154624781
Name:SD PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:SD PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIANA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-415-7639
Mailing Address - Street 1:10769 WOODSIDE AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-3175
Mailing Address - Country:US
Mailing Address - Phone:619-448-1216
Mailing Address - Fax:888-291-4799
Practice Address - Street 1:10769 WOODSIDE AVE STE 205
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3175
Practice Address - Country:US
Practice Address - Phone:619-448-1216
Practice Address - Fax:888-291-4799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21878103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty