Provider Demographics
NPI:1093008484
Name:CHERIE, CAROLYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:CHERIE
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 1:2737 E COAST HWY STE B
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2110
Mailing Address - Country:US
Mailing Address - Phone:949-355-9655
Mailing Address - Fax:
Practice Address - Street 1:2737 E COAST HWY STE B
Practice Address - Street 2:
Practice Address - City:CORONA DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92625-2110
Practice Address - Country:US
Practice Address - Phone:949-355-9655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical