Provider Demographics
NPI:1013024611
Name:STORRS, ROGER BRIAN (PH D)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:BRIAN
Last Name:STORRS
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9683 TIERRA GRANDE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-6503
Mailing Address - Country:US
Mailing Address - Phone:858-695-2237
Mailing Address - Fax:
Practice Address - Street 1:9683 TIERRA GRANDE ST STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-6503
Practice Address - Country:US
Practice Address - Phone:858-695-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6992103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY069922Medicaid
CAPSY069922Medicaid
CAWCP6992AMedicare ID - Type Unspecified