Provider Demographics
NPI:1093590564
Name:BARTLETT, JOEL OTTO (PSYD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:OTTO
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 8TH AVE UNIT 724
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5566
Mailing Address - Country:US
Mailing Address - Phone:651-292-9649
Mailing Address - Fax:651-292-9649
Practice Address - Street 1:34800 BOB WILSON DR STE 6
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1006
Practice Address - Country:US
Practice Address - Phone:619-532-5761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling