Provider Demographics
NPI:1528138013
Name:ALLARD, CAROLYN BRIGITTE (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:BRIGITTE
Last Name:ALLARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 EL CAJON BLVD
Mailing Address - Street 2:STE B, PMB476
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115
Mailing Address - Country:US
Mailing Address - Phone:619-630-9811
Mailing Address - Fax:
Practice Address - Street 1:1761 HOTEL CIRCLE SOUTH
Practice Address - Street 2:STE 315
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-630-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAPSY22359103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral