Provider Demographics
NPI:1285147140
Name:GOSNEY, CLARISSA J (PSYD)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:J
Last Name:GOSNEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12581 BRICKELLIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3703
Mailing Address - Country:US
Mailing Address - Phone:619-800-3811
Mailing Address - Fax:
Practice Address - Street 1:16959 BERNARDO CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2555
Practice Address - Country:US
Practice Address - Phone:858-354-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29633103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical